Intraneural Steroid Injection as a Complication in the Management of Carpal Tunnel Syndrome A Report of Three Cases

McConnell, Jeffrey R.; Bush, David C.

doi:10.1097/00003086-199001000-00024

Cited by 65 publications

(64 citation statements)

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“…[6][7][8][9][10][11][12] En 1966, Phalen 8 analiza su experiencia en 654 pacientes con StC, 270 fueron tratados con un corticoide local. Las complicaciones que describe son un caso de neuritis química del nervio mediano en un paciente sometido a 28 infiltraciones previas, y presenta una foto de la inyección intraneural del corticoide, que muestra el depósito de una sustancia blanquecina sobre el nervio, sin describir la clínica del paciente.…”

Section: Discussionunclassified

Neuritis química post-infiltración en síndrome del túnel carpiano.

Olivera

Jabif

Rodríguez

et al. 2017

Rev. Asoc. Arg. Ort. y Traumatol

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65 ResumenLa inyección local de corticoide es una de las opciones de tratamiento conservador para el síndrome del túnel carpiano leve o moderado, son pocos los reportes de lesión del nervio mediano por inyección intraneural. Comunicamos un caso de neuritis química del nervio mediano posterior a la infiltración con corticoide local en un hombre de 42 años con síndrome del túnel carpiano. Se le realizó neurólisis, epineurotomía y desbridamiento del material inyectado. Se han descrito varias técnicas de infiltración a nivel del túnel del carpo. En este reporte, se discuten los límites anatómicos del túnel del carpo, las técnicas de infiltración y las opciones terapéuticas si surge esta complicación. Se recomienda aplicar la inyección cubital al tendón del palmaris longus 1,5 cm proximal al pliegue de flexión de la muñeca. Colocada la aguja se pregunta al paciente si siente parestesias o dolor en el territorio del nervio mediano, si la respuesta es afirmativa, el procedimiento debe detenerse y se debe redireccionar la aguja.Palabras clave: Síndrome del túnel carpiano; nervio mediano; corticoide; inyección; tratamiento conservador. Nivel de Evidencia: IV Chemical neuritis after steroid injection in a patient with carpal tunnel syndrome. Case report AbstractLocal steroid injection is one of the non-operative treatment options in patients with mild or moderate carpal tunnel syndrome; reports of intra-neural median nerve injection injury from this practice are rare. A case of median nerve chemical neuritis after steroid injection in a 42 years old man with carpal tunnel syndrome is presented. He was treated with neurolysis, epineurotomy, and debridement of the injected material. Several carpal tunnel injection techniques have been described in the literature. Carpal tunnel anatomical landmarks, injection techniques and treatment options of this complication are discussed in this report. We recommend administering the injection ulnar to the palmaris longus tendon 1.5 cm proximal to the flexion crease of the wrist. After the needle is placed, the patient is asked for any pain or paresthesia in the distribution of the median nerve, if the answer is affirmative, the injection should be stopped and redirected.Key words: Carpal tunnel syndrome; median nerve; steroid; injection; conservative treatment. Level of Evidence: IV Neuritis química posinfiltración con corticoide en un paciente con síndrome del túnel carpiano

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Section: Discussionunclassified

Neuritis química post-infiltración en síndrome del túnel carpiano.

Olivera

Jabif

Rodríguez

et al. 2017

Rev. Asoc. Arg. Ort. y Traumatol

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“…There is no consensus amongst authors with regard to the best injection site in the CT; therefore, there is no definitive technique for optimal placement of steroid injection into the CT [15]. The various recommended sites of injection into the CT include: midway between the PLT and the flexor carpi ulnaris (FCU) tendon [3,7], just medial to the PLT [13,22], between PLT and flexor carpi radialis (FCR) tendon [8,11], just medial to the FCR tendon [10] and through the FCR tendon [5] (Table 2).…”

Section: Discussionmentioning

confidence: 99%

“…Injections into the CT are widely performed during diagnostic and therapeutic procedures in the management of CT syndrome [5]. A major complication of CT injection is an intraneural injection into or a direct needle injury to the MN [13,23]. This accidental injury of the MN is extremely painful and may result in serious and prolonged or even permanent disability of the hand [15].…”

Section: Introductionmentioning

confidence: 99%

Determination of the median nerve safe-zone in the carpal tunnel using the distal forearm bony prominences

et al. 2014

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“…In our series, they were patients over 60 years old. It is rare at the child with a noisy clinical picture [10].…”

Section: ) Epidemiologymentioning

confidence: 99%

“…This very painful accident can lead to a lasting or even definitive sensory deficit. Prevention is based on good positioning of the needle, but there is no consensus on this in the literature [10] [11]. Surgical treatment (neurolysis of the median nerve) occurs only after failure of medical treatment [12] [13].…”

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confidence: 99%