Carpal Tunnel Injections: A Novel Approach Based on Wrist Width

Abstract

Introduction Carpal tunnel steroid injections (CTIs) have the potential risk of damaging underlying critical structures, including the median nerve (MN), radial artery (RA), and ulnar neurovascular bundle (UB). The purpose of this study was to analyze the safety of a volar radial (VR) and volar ulnar (VU) CTI, using standardized anatomical “safe zones.”

Materials and Methods This study was performed on 87 cadaveric arms using a percentage of the total wrist width as a guide for placement of a VR (30 and 33% of total wrist width) and VU (60 and 66% of total wrist width) injection.

Results Our results demonstrate a wide range of anatomic variations in the location of these critical neurovascular structures near the carpal canal, indicating that using superficial landmarks alone for CTIs may result in an increased risk of iatrogenic injury to these critical structures.

Discussion We propose a technique using a percentage of total wrist width as a guide for CTIs. Both VR (30% of wrist width) and VU (60% of wrist width) CTIs offer relatively safe and reliable CTI locations to the carpal canal.

Level of Evidence Not applicable/cadaveric study.

Keywords

anatomic location - carpal tunnel - safety - steroid injection

Note

This article does not contain any studies with human participants or animals performed by any of the authors.

• References

• 1 Edgell SE, McCabe SJ, Breidenbach WC, LaJoie AS, Abell TD. Predicting the outcome of carpal tunnel release. J Hand Surg Am 2003; 28 (2) 255-261
• 2 Feuerstein M, Burrell LM, Miller VI, Lincoln A, Huang GD, Berger R. Clinical management of carpal tunnel syndrome: a 12-year review of outcomes. Am J Ind Med 1999; 35 (3) 232-245
• 3 Gonzalez MH, Bylak J. Steroid injection and splinting in the treatment of carpal tunnel syndrome. Orthopedics 2001; 24 (5) 479-481
• 4 Graham RG, Hudson DA, Solomons M, Singer M. A prospective study to assess the outcome of steroid injections and wrist splinting for the treatment of carpal tunnel syndrome. Plast Reconstr Surg 2004; 113 (2) 550-556
• 5 Green DP. Diagnostic and therapeutic value of carpal tunnel injection. J Hand Surg Am 1984; 9 (6) 850-854
• 6 Katz JN, Keller RB, Simmons BP , et al. Maine Carpal Tunnel Study: outcomes of operative and nonoperative therapy for carpal tunnel syndrome in a community-based cohort. J Hand Surg Am 1998; 23 (4) 697-710
• 7 McGrath MH. Local steroid therapy in the hand. J Hand Surg Am 1984; 9 (6) 915-921
• 8 Weiss A-P, Sachar K, Gendreau M. Conservative management of carpal tunnel syndrome: a reexamination of steroid injection and splinting. J Hand Surg Am 1994; 19 (3) 410-415
• 9 Phalen GS. The carpal-tunnel syndrome. Seventeen years' experience in diagnosis and treatment of six hundred fifty-four hands. J Bone Joint Surg Am 1966; 48 (2) 211-228
• 10 Ozdoğan H, Yazici H. The efficacy of local steroid injections in idiopathic carpal tunnel syndrome: a double-blind study. Br J Rheumatol 1984; 23 (4) 272-275
• 11 Schuchmann JA, Melvin JL, Duran RJ, Coleman CR. Evaluation of local steroid injection for carpal tunnel syndrome. Arch Phys Med Rehabil 1971; 52 (6) 253-255
• 12 Wood MR. Hydrocortisone injections for carpal tunnel syndrome. Hand 1980; 12 (1) 62-64
• 13 Frederick HA, Carter PR, Littler JW. Injection injuries to the median and ulnar nerves at the wrist. J Hand Surg Am 1992; 17 (4) 645-647
• 14 Racasan O, Dubert T. The safest location for steroid injection in the treatment of carpal tunnel syndrome. J Hand Surg [Br] 2005; 30 (4) 412-414
• 15 Gelberman RH, Aronson D, Weisman MH. Carpal-tunnel syndrome. Results of a prospective trial of steroid injection and splinting. J Bone Joint Surg Am 1980; 62 (7) 1181-1184
• 16 Grassi W, Farina A, Filippucci E, Cervini C. Intralesional therapy in carpal tunnel syndrome: a sonographic-guided approach. Clin Exp Rheumatol 2002; 20 (1) 73-76
• 17 Dubert T, Racasan O. A reliable technique for avoiding the median nerve during carpal tunnel injections. Joint Bone Spine 2006; 73 (1) 77-79
• 18 Koo JT, Szabo RM. Compression neuropathies of the median nerve. J Am Soc Surg Hand 2004; 4 (3) 156-175
• 19 McConnell JR, Bush DC. Intraneural steroid injection as a complication in the management of carpal tunnel syndrome. A report of three cases. Clin Orthop Relat Res 1990; (250) 181-184
• 20 Kay NRM, Marshall PD. A safe, reliable method of carpal tunnel injection. J Hand Surg Am 1992; 17 (6) 1160-1161
• 21 Minamikawa Y, Peimer CA, Kambe K, Wheeler DR, Sherwin FS. Tenosynovial injection for carpal tunnel syndrome. J Am Soc Surg Hand 1992; 17 (1) 178-181