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

Carpal tunnel injections are widely performed for diagnostic and therapeutic purposes. Injury to the median nerve is a serious and fairly common complication. There is no consensus regarding the safest injection site. The objective of this study was to determine the safest injection site based on an...

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Bibliographic Details
Published in:Joint, bone, spine : revue du rhumatisme bone, spine : revue du rhumatisme, 2006, Vol.73 (1), p.77-79
Main Authors: Dubert, Thierry, Racasan, Otilia
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Arthroscopy - adverse effects
Arthroscopy - methods
Carpal Joints
Carpal tunnel
Carpal tunnel syndrome
Carpal Tunnel Syndrome - diagnostic imaging
Carpal Tunnel Syndrome - drug therapy
Female
Flexor carpi radialis
Glucocorticoid injection
Glucocorticoids - administration & dosage
Glucocorticoids - therapeutic use
Humans
Injections, Intra-Articular
Male
Median Nerve - injuries
Middle Aged
Palmaris longus
Retrospective Studies
Tomography, X-Ray Computed
Trauma, Nervous System - etiology
Trauma, Nervous System - prevention & control
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Summary:Carpal tunnel injections are widely performed for diagnostic and therapeutic purposes. Injury to the median nerve is a serious and fairly common complication. There is no consensus regarding the safest injection site. The objective of this study was to determine the safest injection site based on anatomical data. During 124 endoscopic procedures for median nerve release at the carpal tunnel, we measured the distances separating the median nerve, palmaris longus (PL), flexor carpi radialis (FCR), and flexor carpi ulnaris 1 cm proximal to the wrist crease. The edge of the median nerve extended medially beyond the PL tendon in 82 (88%) hands. Thus, needle insertion within 1 cm of either edge of the PL tendon may cause median nerve injury; with injection sites located further toward the medial edge, the ulnar pedicle may be at risk. Consequently, we recommend that carpal tunnel injections be performed through the FCR tendon.
ISSN:1297-319X
DOI:10.1016/j.jbspin.2005.02.006