Department of Orthopaedics, University of Colorado School of Medicine, 1635 Aurora Ct, Aurora, CO, 80045, USA.
Department of Orthopaedics, Denver Health Medical Center, 777 Bannock St, Denver, CO, 80204, USA.
Eur J Orthop Surg Traumatol. 2023 Oct;33(7):2995-2999. doi: 10.1007/s00590-023-03515-z. Epub 2023 Mar 19.
Carpal tunnel (CT) syndrome continues to be a commonly treated hand pathology. We aimed to evaluate several CT injection techniques for (1) spatial accuracy within the CT and (2) risk of median nerve (MN) injury. Our purpose was to evaluate for any significant differences in accuracy of needle placement within the carpal tunnel and final distance between the needle tip and the MN with each technique.
Fifteen fresh frozen cadaveric arms were used for this study. Six different injection techniques for CT injection were performed on each specimen, including palmaris longus, ulnar to flexor carpi radialis, trans-flexor carpi radialis, volar radial, volar ulnar, and direct through the palm techniques. After needle placement, a standard open CT release was performed to assess for accuracy of placement within the CT and measure needle position in relation to the MN and other anatomic structures.
Accurate intra-CT needle placement was seen in 91% of injections. While there was no significant difference between injection techniques for distance to nearest tendon (p = 0.1531), the trans-flexor carpi radialis (tFCR), volar radial (VR), and volar ulnar (VU) techniques consistently provided the greatest intra-CT distance from needle tip to median nerve (p = 0.0019). The least incidence of intraneural needle placement was found with the tFCR and VR approaches.
All six injection techniques reliably enter the CT space. The lowest risk to the MN was found with tFCR and VR techniques, and we recommend these techniques for safe and effective needle placement to avoid iatrogenic intraneural injection.
Level V: Cadaveric Study.
腕管（CT）综合征仍然是一种常见的手部病理治疗方法。我们旨在评估几种 CT 注射技术，以评估（1）在 CT 内的空间准确性和（2）正中神经（MN）损伤的风险。我们的目的是评估每种技术在 CT 内放置针的准确性和最终针尖与 MN 之间的距离方面是否存在任何显著差异。
本研究使用了 15 个新鲜冷冻的尸体手臂。对每个标本进行了六种不同的 CT 注射技术，包括掌长肌、尺侧到屈肌、经屈肌、掌侧桡侧、掌侧尺侧和直接经手掌技术。放置针后，进行标准的开放式 CT 松解术，以评估在 CT 内的放置准确性，并测量针的位置与 MN 和其他解剖结构的关系。
91%的注射实现了准确的 CT 内针放置。虽然在距离最近肌腱的注射技术之间没有显著差异（p=0.1531），但经屈肌、掌侧桡侧和掌侧尺侧技术始终提供了从针尖到正中神经的最大 CT 内距离（p=0.0019）。经屈肌和掌侧桡侧技术发现针内神经内放置的发生率最低。
所有六种注射技术都能可靠地进入 CT 空间。经屈肌和掌侧桡侧技术对 MN 的风险最低，我们建议使用这些技术进行安全有效的针放置，以避免医源性神经内注射。
5 级：尸体研究。
