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Carpal Tunnel Injection / Median Nerve Block

- 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           - avoid going directly into nerve, & if paresthesia's are elicited needle should be withdrawn & placed in more ulnarly or radially;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           - if paresthesias are elicited, needle is withdrawn & repositioned;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.
Comparison of Needle Position Proximity to the Median Nerve in 2 Carpal Tunnel Injection Methods: A Cadaveric Study 

Local corticosteroid treatment for carpal tunnel syndrome: a 6-month clinical and electrophysiological follow-up study.

Local corticosteroid injection for carpal tunnel syndrome.

Comparison of carpal tunnel injection techniques: a cadaver study

A reliable technique for avoiding the median nerve during carpal tunnel injections

The safest location for steroid injection in the treatment of carpal tunnel syndrome

Comparison of open carpal tunnel release and local steroid treatment outcomes in idiopathic carpal tunnel syndrome