2023 Workshop Handout Bundle-Advanced Sonographic Needle Guidance for Carpal Tunnel Injections

Advanced Sonographic Needle Guidance for Carpal Tunnel Injections

Pdf Summary

Dr. Elena Shanina's workshop, "Sonographic Needle Guidance for Carpal Tunnel Injections," at the 2023 AANEM Annual Meeting, addresses the use of ultrasound (US) to enhance the accuracy and safety of carpal tunnel corticosteroid injections. Carpal tunnel syndrome (CTS) is a prevalent condition where corticosteroid injections are commonly used as an effective treatment method. However, incorrect needle placement can lead to severe complications, such as median nerve injury. <br /><br />Using ultrasound for guidance provides a real-time view of the needle and anatomical structures, enabling accurate positioning and reducing the risk of neurovascular injuries. The workshop details the sonoanatomy of the carpal tunnel area, emphasizing the hyperechoic characteristics of bony landmarks (scaphoid and pisiform bones) and the distinct appearance of the median nerve relative to surrounding tendons. This accurate visualization aids in differentiating these structures and planning a safe needle trajectory.<br /><br />The workshop covers two primary needle approaches: <br />1. **In-Plane Approach**: The needle is inserted parallel to the US beam, allowing the entire needle shaft to be visible. This approach is preferred for its superior visualization and safety in carpal tunnel injections.<br />2. **Out-of-Plane Approach**: The needle is introduced perpendicular to the US beam, offering a cross-sectional view but less effective needle visualization.<br /><br />Techniques like hydrodissection, which involve the introduction of fluid to separate the median nerve from surrounding tissues, are also discussed. Utilizing a high-frequency linear transducer (15-18 MHz) ensures optimal imaging of superficial nerves.<br /><br />US guidance is compared to the traditional "blind method," revealing that US-guided injections result in fewer complications and better placement accuracy. Blind injections, despite being effective historically, have higher incidences of nerve and vascular injuries.<br /><br />The workshop emphasizes the procedural preparation and execution, along with the sterile technique and proper documentation required for billing and coding. The inclusion of figures illustrates anatomical landmarks and various injection techniques, complementing the instructional material.<br /><br />Overall, Dr. Shanina advocates for US-guided carpal tunnel injections to improve procedural success and minimize risks, highlighting their effectiveness and the necessity for correct implementation.

Keywords

Sonographic Needle Guidance

Carpal Tunnel Injections

Ultrasound

nmus

sono

Corticosteroid Injections

Median Nerve Injury

Sonoanatomy

In-Plane Approach

Out-of-Plane Approach

Hydrodissection

High-Frequency Linear Transducer

ultrasound

nmus

sono

ultrasound