- Injection of Steroid in pts w/ CTS:
- injection of
steroids into carpal tunnel can be an effective method of treatment in the short term;
- if steroid is injected directly into
median nerve, dysesthesias may occur and persist for several weeks;
- note that steroid injections into the carpal tunnel may temporarily "normalize" nerve conduction studies, and therefore the physician may consider
delaying a steroid injection until the NCS is completed;
-
indications:
- no profound sensory loss
- no thenar atrophy
- only slightly prolonged
nerve-conduction latencies;
- Anatomy:
-
median nerve is found at proximal flexor crease of wrist between
palmaris longlus &
FCR tendon, closer to latter;
- if pt does not have palmaris longus tendon, in which case the nerve is just radial to flexor sublimis tendon of fingers, which usually lies below palmaris longus tendon;
- Technique: CTS Injection;
- use 25-27 (5/8 in.) needle, w/ 1 ml of plain
lidocaine & 1 ml of
steroid (10 mg
dexamethasone or 40mg
triamcinolone);
- avoid going directly into nerve, & if paresthesia's are elicited needle should be withdrawn & placed in more ulnarly or radially;
- 25-gauge needle is inserted 1 cm proximal to distal wrist flexion crease, just ulnar to
palmaris longus tendon at 30 deg
angle directly distally and slightly radially;
- if palmaris longus is absent, the needle should be directed in line w/ ring finger;
- if paresthesias are elicited, needle is withdrawn & repositioned;
- if paresthesias are not elicited 5 ml of solution is injected;
A safe reliable method of carpal tunnel injection.
Injection injuries to the median and ulnar nerves at the wrist.
Intraneural steroid injection as a complication in the management of carpal tunnel syndrome. A report of three cases.
JR McConnel and DC Bush. CORR. Vol 250. 1990. p 181-184.
Comparison of Needle Position Proximity to the Median Nerve in 2 Carpal Tunnel Injection Methods: A Cadaveric Study
