• Dong Hwee Kim, Ji Eun Jang, and Byung Kyu Park.
• Department of Physical Medicine & Rehabiliation, Korea University College of Medicine, Ansan Hospital 516 Gojan-dong, Danwon-gu Ansan-si, Gyeonggi Province, Korea. rmkdh@korea.ac.kr
• Pain Physician. 2013 May 1;16(3):E191-8.

BackgroundLocal steroid injection may be an effective conservative treatment for carpal tunnel syndrome; however, the use of a blind injection technique can increase the chance of median nerve or ulnar artery injury due to median nerve swelling or the close proximity of the median nerve and ulnar artery around the distal wrist crease.ObjectivesThe purpose of this study is to investigate the relative location of the median nerve and ulnar artery to the palmaris longus (PL) tendon around the wrist in carpal tunnel syndrome.Study DesignAn observational study.SettingA university outpatient interventional pain management practice in the Republic of Korea.MethodsThirty hands of 15 patients with carpal tunnel syndrome and 30 hands of 15 healthy subjects were studied. Ultrasonography was performed to determine the relative relationship of the ulnar artery and median nerve to the PL tendon around the wrist.ResultsThere were statistically significant differences both in the distance from the medial margin of the PL to the medial end of the median nerve and the distance from the medial end of the median nerve to the lateral end of the ulnar artery at all levels of scanning between the 2 groups.LimitationsLimitations include the inclusion of a small number of patients with carpal tunnel syndrome.ConclusionIt is important to recognize the risk of blind local steroid injection for carpal tunnel syndrome, which is most likely a result of swelling and/or flattening of the median nerve around the distal wrist crease. A real time, ultrasound-guided local steroid injection is preferred as a safe and accurate technique in carpal tunnel syndrome treatment.

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