Name:
Injection Technique for Carpal Tunnel Syndrome
Description:
Injection Technique for Carpal Tunnel Syndrome
Thumbnail URL:
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Duration:
T00H05M00S
Embed URL:
https://stream.cadmore.media/player/6c23923e-7465-4ddb-885f-fefba48c77d5
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/6c23923e-7465-4ddb-885f-fefba48c77d5/Injection Technique for Carpal Tunnel Syndrome.mp4?sv=2019-02-02&sr=c&sig=nxMPgJRXeDl46JPwOQJzBhlNx7tq9xlTQvUbC%2FjMKwY%3D&st=2024-11-21T14%3A49%3A46Z&se=2024-11-21T16%3A54%3A46Z&sp=r
Upload Date:
2024-06-01T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
Today, I am going to show you how to inject carpal tunnel with steroid and local anesthetic in a symptomatic patient. Now, carpal tunnel syndrome is an extremely common diagnosis, and patients usually report pins and needles in the hand, and it's usually worse in the night. Occasionally they will wake up in the morning with fuzziness or numbness, or they will report numbness in repeated hand movements.
Occasionally, in later stages, they start dropping things. So these are the things to look forward or to look for in a patient with carpal tunnel. Now, steroid injection is one of the treatment options. It is a pretty good tool in alleviating pain and in a small percentage of patients, it ca be curative as well. Now, if you have steroid injection and your symptoms get better, usually there are multiple studies they will show it will make your symptoms better up to anywhere around 20% to 30% of the patients.
But in my experience, there are a lot of patients whom I have injected and they have never come back to me. That makes me think that it can be of curative value as well. Now, today I'm going to show you how to inject a carpal tunnel safely in a patient who has got carpal tunnel syndrome. So our patient is ready. It is extremely important to have to have cleaned the area.
So we have cleaned the whole area, whole hand actually with betadine and alcohol. The landmark that you need to identify if you want to inject a carpal tunnel properly is first is this distal palmar case. So you can see that. Now the two important tendons that you need to identify are palmaris longus. So if you ask a patient to do this.
You will see this tendon popping up. So if I mark this here, this is Palmaris longus, and if I ask patient to do this, you can see this tendon popping up and this is your FCR. So FCR here. And palmaris longus and the distal palmar crease. Now, there are two ways you can inject the carpal tunnel. One is to identify this FCR, sorry,
this palmaris longus and what we call is the ulnar approach. Because you go from the ulnar side. So for this, you identify our ulnar part of the palmaris longus take one centimeter. Ulnar and one centimeter down. So this will be your point of insertion for your ulnar approach? For the radial approach, it's quite easy. And that is what I prefer.
You just have to go in between tendon and roughly a centimeter proximal. Some people may say 1 and 1/2 or 2 centimeter is what I would choose. If you watch my video for carpal tunnel decompression, you have I have shown you some landmarks. And normally if I want to show you where is the skin incision? The skin incision is straight. If you draw a straight line from here.
And coming up down there. So your incision is roughly here. And when you make the skin incision, you will find median nerve directly underneath it. So if you go to the radial border of the ring finger, that is your incision for carpal tunnel. And the reason I use radial approach is because you have to angle your needle at roughly somewhere between 20 to 40 degrees.
I keep it around 30 degrees. So if you angle it like this and you are away from the median nerve because median nerve is slightly more ulnar, and that is the reason I prefer to go in between the tendons and I will be one centimeter proximal. So now I'm ready for my injection and I will show you how I do it. A cocktail. If you are doing an ultrasound guided, you can just give steroid one or two ML depending upon your choice.
When I do it blind, I always increase the volume. So that even if you are not at a perfect position, it will spread and you will get a good results. So I'm ready. This is my site of the injection. Roughly 30 degrees and just go straight in. If at any point, if you're close to the median nerve, patient will complain a sharp shooting pain and occasionally you may see a twitch. [VIDEO ENDS]
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