Carpal Tunnel Injection - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes injection of the carpal tunnel - median nerve compression.
As the median nerve travels through the carpal tunnel, it may become compressed. Carpal tunnel syndrome is the condition of pressure being placed on the median nerve. The transverse carpal ligament is usually thickened at the wrist which causes compression of the nerve, the condition usually occurs due to overuse injury such as repetitive handgrip movements.
Carpal tunnel syndrome predisposing factors:
•Trauma
•Fractures
•Pregnancy
•Diabetes
•Rheumatoid arthritis
•Ganglion cyst.
As a result of this compression, the patient may experience pain and paresthesia in the median nerve distribution, as well as weakness in the hand.
Steroid injection is often used and may be successful to treat some patients who suffer from carpal tunnel syndrome. The median nerve is located between the palmaris longus and the flexor carpi radialis tendons.
Surface anatomy for injection
The course of the flexor carpi radialis, palmaris longus and the distal palmar crease should be identified and marked. The injection can be given either blind or with ultrasound guidance. The blind injection can be performed by the usual approach or by the proximal approach.
Usual approach:
•Mark the intersection of the palmaris longus tendon and the distal palmar crease.
•Next go 1 cm proximal and 1 cm ulnar to that site, this will then be the point of injection.
•Use a 25 gauge needle with desired steroid and 1 ml of 1 % lidocaine.
•Warn the patient before injection that if any feeling of numbness, paresthesia or severe pain exists, to let the physician know about it. If these symptoms exist, the doctor should withdraw the needle or adjust it before injection.
•May use local anesthesia or spray.
•Use a sterile field.
•Put the needle at a 45-degree angle to the skin of the wrist.
•Direct the needle towards the base of the thumb and advance the needle distally and slowly.
Proximal approach:
•Mark the site 4-5 cm proximal to the distal palmar crease and between the palmaris longus and the flexor carpi radialis tendons.
•Advance the needle distally towards the wrist at about a 20-degree angle from the skin.
•Keep the needle between the two tendons.
•Be aware that the nerve is in between the two tendons and adjust the needle as needed.
•Inject the desired fluid.
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