Carpal Tunnel Injection for Carpal Tunnel Syndrome

Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA

CARPAL TUNNEL INJECTION FOR CARPAL TUNNEL SYNDROME

Carpal tunnel syndrome is caused by compression of the median nerve at the level of wrist

CLINICAL FEATURES

• Patient c/o pain & paresthesia that awakens the patient at night with hand weakness
• clumsiness & numbness in the index finger and thumb
• severe cases causes wasting of thenar muscle

DIAGNOSIS

• Is mainly Clinical

FINDINGS :

• Positive Tunnel test Positive Durkan’s test
• Positive phalen test
• EMG & Nerve conduction studies show the compression of median nerve
• EMG the more severe, the improvement will be less likely.

TREATMENT

• Night splints
• NSAIDS
• Activity modification
• Steroid injection
  – Can be done using ultrasound guidance or blind
  – injection is given in the Carpal tunnel around the nerve.
  – if the patient has a temporary improvement after the steroid injection, then this is a good prognostoc sign that the patient will have good result after surgery

Surgery
– Done if there is failure of non operative treatment (including splinting & steroid injection)

ADVANTAGES OF STEROID INJECTION

• Provides relief of symptoms by suppressing the local inflammation
• cost effective
• safe to relieve carpal tunnel symptoms

DISADVANTAGES OF STEROID INJECTION

When steroid was given within 30 days preoperatively

• Increased risk of surgical site infection
• Non infectious wound complications
• Increased one year reoperation rate.