2025 Workshop Handout Bundle-W74C Advaced Sonographic Needle Guide CTS

W74C Advaced Sonographic Needle Guide CTS - Shanina

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This document by Dr. Elena Shanina focuses on the use of ultrasound (US)-guided needle injections for treating carpal tunnel syndrome (CTS), the most common entrapment neuropathy. Key objectives include understanding the sonoanatomy of the carpal tunnel, techniques for sonographic needle guidance, comparing US-guided versus blind injections, recognizing anatomical variations, and demonstrating injection procedures.<br /><br />CTS affects 1-3 per 1,000 people annually in the U.S., with steroid injections commonly used for treatment. However, blind injections risk median nerve injury and vascular complications due to imprecise needle placement. Ultrasound guidance offers real-time visualization of the median nerve, tendons, arteries, and the needle, improving safety and accuracy.<br /><br />Sonoanatomy highlights bony landmarks (pisiform and scaphoid bones), the median nerve typically oval and superficial, tendons within the tunnel, and vascular structures like the ulnar artery. Anatomical variations such as bifid median nerve and persistent median artery must be identified pre-procedure.<br /><br />Two needle approaches exist: in-plane, where the needle is aligned with the US beam allowing full visualization (preferred for carpal tunnel), and out-of-plane, which has limited needle visibility. Needle insertion is commonly from the ulnar side, and transverse (short-axis) US views provide optimal visualization of nerve, needle, and injectate spread.<br /><br />Clinical indications include mild-to-moderate CTS with symptoms unresponsive to conservative care. Contraindications include infection, allergies, uncontrolled diabetes, and immunosuppression.<br /><br />Studies show US-guided injections significantly reduce nerve injury risk and improve treatment efficacy compared to blind methods, which have 8-9% incidence of inadvertent nerve penetration. US guidance allows precise needle placement adjacent to median nerve epineurium and hydrodissection to separate nerve from surrounding tissues.<br /><br />The procedure uses a high-frequency linear transducer (15-18 MHz), sterile technique, lidocaine, and corticosteroids (e.g., methylprednisolone). Documentation and billing codes are provided.<br /><br />In summary, US-guided carpal tunnel injections enhance safety, accuracy, and outcomes versus blind injections by enabling direct visualization of the median nerve and surrounding anatomy, minimizing risks of nerve or vascular injury.

Keywords

carpal tunnel syndrome

CTS

ultrasound-guided injections

median nerve

sonoanatomy

needle guidance techniques

in-plane needle approach

ulnar side insertion

hydrodissection

corticosteroid injection

nerve injury prevention