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Subject: Carpal Tunnel Syndrome Injection
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Povidone-iodine (or equivalent skin antiseptic)
Syringe, 5 cc
Lidocaine 1% without epinephrine
Steroid (0.5 cc) such as betamethasone (Celestone) or triamcinolone
Signs and symptoms suggesting median nerve compression in the carpal canal with the absence of severe symptoms or pain and absence of severe signs such as thenar muscle wasting
Usually not done in pediatric populations
Avoid during third trimester of pregnancy
Overlying skin with signs and symptoms of cellulitis or infection
A mass in the canal
History of bleeding disorders or coagulopathy
Uncooperative patient (relative)
PITFALL: The needle should pass easily into the canal. With resistance, withdraw and redirect the needle, still aiming for the tip of the third digit.
PITFALL: If the needle touches or penetrates the nerve itself, the patient may experience pain and numbness in the median nerve distribution. Ask the patient to report if this happens. If the needle tip touches the nerve, withdraw and redirect the needle slightly upward but still aiming for the tip of the third digit.
Increased pain after steroid injection (temporary and usually resolves in 48 hours)
Accidental injection into the median nerve
Bruising of the skin