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Sonographically Guided Carpal Tunnel Injections

The Ulnar Approach

Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Mayo Clinic Sports Medicine Center, Rochester, Minnesota USA (J.S., J.T.F., J.M.P.); and The Rehab Doctors, Rapid City, South Dakota USA (S.J.W.).

Address correspondence to Jay Smith, MD, Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Mayo Clinic Sports Medicine Center, E10, Mayo Building, 200 First St SW, Rochester, MN 55905 USA. E-mail: smith.jay{at}mayo.edu

Objective. The purpose of this report is to describe a new sonographically guided technique for carpal tunnel injections using an ulnar approach. Methods. Previously published sonographically guided techniques for carpal tunnel injections were reviewed. Described approaches were noted to be technically challenging because of the need to perform long-axis imaging of the carpal tunnel, short-axis (out-of-plane) imaging of the needle, or both. Results. We developed and herein describe the ulnar approach for sonographically guided carpal tunnel injections. Advantages of this approach include transverse imaging of the carpal tunnel, long-axis (in-plane) imaging of the needle, and versatility in targeting structures within the carpal tunnel. Conclusions. Clinicians should consider the ulnar-sided approach when performing sonographically guided carpal tunnel injections.

Key Words: carpal tunnel syndrome • injections • sonography • wrist