Accuracy of Carpal Tunnel Injection: A Prospective Evaluation of 756 Patients.
Background: Corticosteroid injection into the carpal tunnel is both a diagnostic test and a therapeutic modality in the treatment of carpal tunnel syndrome. Many injection techniques are described in the literature. Improper placement of injection may result in damage to neurovascular structures in the carpal canal or decrease efficacy of the test and/or therapy. The purpose of this study is to determine if carpal tunnel injection using anatomic landmarks is reproducible and safe. A review of the senior author's injection technique is presented. Methods: Over 8 years, there were 756 attempted placements of a 25-gauge needle into the carpal tunnel in a simulated carpal tunnel injection prior to open carpal tunnel release. The needle was inserted at the wrist crease, just ulnar to palmaris longus. Open carpal tunnel release was subsequently performed, and position of the needle was recorded. Results: In 572 patients (75.7%), the needle was found to be in the carpal tunnel without penetration of contents. The needle was in the carpal tunnel but piercing the median nerve in 66 attempts (8.7%). The carpal tunnel was missed in 118 attempts (15.6%). Conclusions: This is the largest study looking at accuracy of carpal tunnel injection using anatomic landmarks. Our injection accuracy (75.7%) is less than reported in previous studies, which note 82% to 100% accuracy using the same injection technique. This may indicate that carpal tunnel injection is less reliable than previously thought. Safety of carpal tunnel injection remains an important concern. The median nerve was penetrated in 8.7% of attempts.
['Green|David P|DP|', 'MacKay|Brendan J|BJ|', 'Seiler|Steven J|SJ|', 'Fry|Michael T|MT|']
D000293:Adolescent D000305:Adrenal Cortex Hormones D000328:Adult D000368:Aged D000369:Aged, 80 and over D059925:Anatomic Landmarks D002349:Carpal Tunnel Syndrome D019299:Decompression, Surgical D005260:Female D006801:Humans D007270:Injections, Intra-Articular D008297:Male D008475:Median Nerve D019300:Medical Errors D008875:Middle Aged D009339:Needles D011446:Prospective Studies D015203:Reproducibility of Results D014457:Ulna D014953:Wrist D055815:Young Adult
carpal tunnel carpal tunnel injection carpal tunnel syndrome injection technique anatomic landmarks median nerve injection accuracy