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Anatomic Landmarks to Locate the Median Nerve for Safe Wrist Block or Carpal Tunnel Steroid Injection

Introduction: Carpal tunnel syndrome is the most common entrapment neuropathy involving the upper extremity. As such, various nonoperative techniques have been developed to aid in management of mild to moderate disease, including local steroid injection. However, definitive guidelines for needle/inj...

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Autores principales: Brooks, Ron, Kistler, Amanda, Chowdhry, Saeed, Swiergosz, Andrew, Perlin, Katharina, Kasdan, Morton L., Wilhelmi, Bradon J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Open Science Company, LLC 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6727415/
https://www.ncbi.nlm.nih.gov/pubmed/31501688
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author Brooks, Ron
Kistler, Amanda
Chowdhry, Saeed
Swiergosz, Andrew
Perlin, Katharina
Kasdan, Morton L.
Wilhelmi, Bradon J.
author_facet Brooks, Ron
Kistler, Amanda
Chowdhry, Saeed
Swiergosz, Andrew
Perlin, Katharina
Kasdan, Morton L.
Wilhelmi, Bradon J.
author_sort Brooks, Ron
collection PubMed
description Introduction: Carpal tunnel syndrome is the most common entrapment neuropathy involving the upper extremity. As such, various nonoperative techniques have been developed to aid in management of mild to moderate disease, including local steroid injection. However, definitive guidelines for needle/injection location have not been defined, especially in relation to diminishment of iatrogenic injury to the median nerve. Methods: A cadaveric study was designed to determine the average width of the median nerve, as well as its location specifically in relation to the palmaris longus (if present), the flexor carpi radialis, and the midpoint of the wrist. All measurements were obtained at the radial tip of the interstyloid line. Results: Data demonstrated that the average width of the median nerve was 7.85 mm and that it lies ulnar in location to the palmaris longus (3 mm), as well as the midpoint of the wrist at the radial tip of the interstyloid line (0.43 mm). Furthermore, the distance between the median nerve and the flexor carpi radialis was measured to be 9.57 mm. Outcomes: Therefore, injection location should be radial with respect to the palmaris longus and the midline of the wrist. It can be just ulnar to the flexor carpi radialis tendon or between 8 and 10 mm radial to the midpoint of the wrist in order to prevent median nerve injection and direct trauma to the nerve.
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spelling pubmed-67274152019-09-09 Anatomic Landmarks to Locate the Median Nerve for Safe Wrist Block or Carpal Tunnel Steroid Injection Brooks, Ron Kistler, Amanda Chowdhry, Saeed Swiergosz, Andrew Perlin, Katharina Kasdan, Morton L. Wilhelmi, Bradon J. Eplasty Journal Article Introduction: Carpal tunnel syndrome is the most common entrapment neuropathy involving the upper extremity. As such, various nonoperative techniques have been developed to aid in management of mild to moderate disease, including local steroid injection. However, definitive guidelines for needle/injection location have not been defined, especially in relation to diminishment of iatrogenic injury to the median nerve. Methods: A cadaveric study was designed to determine the average width of the median nerve, as well as its location specifically in relation to the palmaris longus (if present), the flexor carpi radialis, and the midpoint of the wrist. All measurements were obtained at the radial tip of the interstyloid line. Results: Data demonstrated that the average width of the median nerve was 7.85 mm and that it lies ulnar in location to the palmaris longus (3 mm), as well as the midpoint of the wrist at the radial tip of the interstyloid line (0.43 mm). Furthermore, the distance between the median nerve and the flexor carpi radialis was measured to be 9.57 mm. Outcomes: Therefore, injection location should be radial with respect to the palmaris longus and the midline of the wrist. It can be just ulnar to the flexor carpi radialis tendon or between 8 and 10 mm radial to the midpoint of the wrist in order to prevent median nerve injection and direct trauma to the nerve. Open Science Company, LLC 2019-07-29 /pmc/articles/PMC6727415/ /pubmed/31501688 Text en Copyright © 2019 The Author(s) http://creativecommons.org/licenses/by/2.0/ This is an open-access article whereby the authors retain copyright of the work. The article is distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Journal Article
Brooks, Ron
Kistler, Amanda
Chowdhry, Saeed
Swiergosz, Andrew
Perlin, Katharina
Kasdan, Morton L.
Wilhelmi, Bradon J.
Anatomic Landmarks to Locate the Median Nerve for Safe Wrist Block or Carpal Tunnel Steroid Injection
title Anatomic Landmarks to Locate the Median Nerve for Safe Wrist Block or Carpal Tunnel Steroid Injection
title_full Anatomic Landmarks to Locate the Median Nerve for Safe Wrist Block or Carpal Tunnel Steroid Injection
title_fullStr Anatomic Landmarks to Locate the Median Nerve for Safe Wrist Block or Carpal Tunnel Steroid Injection
title_full_unstemmed Anatomic Landmarks to Locate the Median Nerve for Safe Wrist Block or Carpal Tunnel Steroid Injection
title_short Anatomic Landmarks to Locate the Median Nerve for Safe Wrist Block or Carpal Tunnel Steroid Injection
title_sort anatomic landmarks to locate the median nerve for safe wrist block or carpal tunnel steroid injection
topic Journal Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6727415/
https://www.ncbi.nlm.nih.gov/pubmed/31501688
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