How are carpal tunnel steroid injections administered with the landmark approach?

Updated: May 31, 2018
  • Author: Samir Shah, MD; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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Identify the flexor carpi radialis (lateral) and palmaris longus tendons (medial). Prep the skin using the antiseptic solution.

Using the 25 ga needle make a skin wheel with 1% lidocaine just medial to the palmaris longus tendon and approximately 1 centimeter proximal to the wrist crease.

In a separate syringe draw up the steroid and enter the skin at the skin wheel just medial to the palmaris longus tendon using blunt tip 25 ga needle. Direct the needle toward the third digit at a 30 degree angle. Advance the needle approximately 1.5 -2 cm. Aspirate to verify that the needle is not intravascular and inject the steroid with little or no resistance.

Remove the needle and place the wrist in a gravity-dependent position advising the patient to move the fingers for several minutes to facilitate even distribution of the solution.

The landmark procedure is shown in the video below.

Steroid injection, carpal tunnel.

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