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J Hand Microsurg 2016; 08(01): 021-026
DOI: 10.1055/s-0036-1581192
Original Article
Society of Indian Hand & Microsurgeons

Carpal Tunnel Injections: A Novel Approach Based on Wrist Width

Travis J. Menge
1   The Steadman Clinic, Vail, Colorado, United States
,
Elizabeth B. Rinker
2   Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States
,
Kang-Hsien Fan
3   VICC Cancer Biostatistics Center, Nashville, Tennessee, United States
,
John J. Block
4   Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, Tennessee, United States
,
Donald H. Lee
5   Vanderbilt University Medical Center, Vanderbilt Orthopaedic Institute, Nashville, Tennessee, United States
› Author Affiliations
Further Information

Publication History

20 July 2015

09 March 2016

Publication Date:
27 April 2016 (online)

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Abstract

Introduction Carpal tunnel steroid injections (CTIs) have the potential risk of damaging underlying critical structures, including the median nerve (MN), radial artery (RA), and ulnar neurovascular bundle (UB). The purpose of this study was to analyze the safety of a volar radial (VR) and volar ulnar (VU) CTI, using standardized anatomical “safe zones.”

Materials and Methods This study was performed on 87 cadaveric arms using a percentage of the total wrist width as a guide for placement of a VR (30 and 33% of total wrist width) and VU (60 and 66% of total wrist width) injection.

Results Our results demonstrate a wide range of anatomic variations in the location of these critical neurovascular structures near the carpal canal, indicating that using superficial landmarks alone for CTIs may result in an increased risk of iatrogenic injury to these critical structures.

Discussion We propose a technique using a percentage of total wrist width as a guide for CTIs. Both VR (30% of wrist width) and VU (60% of wrist width) CTIs offer relatively safe and reliable CTI locations to the carpal canal.

Level of Evidence Not applicable/cadaveric study.

Keywords

anatomic location - carpal tunnel - safety - steroid injection

Note

This article does not contain any studies with human participants or animals performed by any of the authors.


 

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