Travis J Menge1, Elizabeth B Rinker2, Kang-Hsien Fan3, John J Block4, Donald H Lee5. 1. The Steadman Clinic, Vail, Colorado, United States. 2. Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States. 3. VICC Cancer Biostatistics Center, Nashville, Tennessee, United States. 4. Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, Tennessee, United States. 5. Vanderbilt University Medical Center, Vanderbilt Orthopaedic Institute, Nashville, Tennessee, United States.
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.
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.
Authors: Abeer K Alhindi; Abdullah A Ghaddaf; Mohammed S Alomari; Jawaher F Alsharef; Saleh A Alzahrani; Mohammed S Alshehri; Hani Sulimani Journal: Arch Orthop Trauma Surg Date: 2022-05-30 Impact factor: 3.067
Authors: B P Krishna Prasad; Binu Joy; Vijayakumar A Raghavendra; Ajith Toms; Danny George; Brijesh Ray Journal: Indian J Radiol Imaging Date: 2018 Jan-Mar