Procedure
Carpal Tunnel Corticosteroid Injection
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Carpal Tunnel Corticosteroid Injection
, Carpal Tunnel Steroid Injection
See Also
Hand Injection
Joint Injection
Injectable Corticosteroid
Indications
Carpal Tunnel Syndrome
Efficacy
Short-term
Reduced symptoms, and improved function and quality of life in 60-70% cases
Short-term relief for at least 6 months, and reduced need for surgery at 12 months
Ashworth (2023) Cochrane Database Syst Rev (2): CD015148 [PubMed]
Long-term
Clinical outcome at one year for steroid injection is similar to surgery
Ly-Pen (2005) Arthritis Rheum 52:612-9 [PubMed]
Precautions
Do not inject into
Median Nerve
Risk of tendon rupture
Injection is harmful if improperly done
Anatomy
Anatomic relationships
Flexor carpi radialis (radial side)
Median Nerve
Palmaris Longus (Ulnar side)
Forms palmar aponeurosis at midline of wrist
Oppose thumb and 5th finger to find palmaris longus
Preparation
Needle: 27 gauge 1.25 inch (or 25 gauge 1.5 inch)
Corticosteroid
Methylprednisolone
: 20-40 mg or
Triamcinolone 20-40 mg or
Celestone Soluspan: 1 ml
Anesthetic
(without
Epinephrine
)
Lidocaine
1%: 2 ml or
Bupivacaine
(
Marcaine
) 0.25%
Technique
Consider
Ultrasound
guidance of injection
Wrist
position
Dorsiflex wrist to 30 degrees resting on towel roll
Injection site
Proximal wrist crease (or 1 cm proximal to most distal wrist crease)
Ulnar side of following landmark
Wrist
midline if palmaris longus absent or
Palmaris longus tendon
Find by opposing thumb with pinky or
Flex middle finger against resistance
Needle insertion
Apply antiseptic to skin (e.g.
Betadine
)
Aim 30-45 degrees distally toward middle-ring finger
Insert needle 1-2 cm until no resistance (nerve is very superficial)
Do not inject if
Paresthesia
s (see below)
Warning: Distal
Paresthesia
s with needle before steroid
Indicates needle is at
Median Nerve
Do not inject here!
Remove needle and replace further to the ulnar side
Follow-up
Anticipate at least 2 weeks to see improvement
Continue
Wrist Splint
use after injection
May be repeated up to 2-3 times
References
Pfenninger (1994) Procedures, Mosby, p. 1036-54
Neustadt in Roberts (1998) Procedures, p. 914-5
Boyer (2008) J Hand Surg Am 33(8): 1414-6 [PubMed]
Tallia (2003) Am Fam Physician 67(4):745-50 [PubMed]
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