What is the role of wrist arthrocentesis in the management of carpal tunnel syndrome?

Updated: Nov 03, 2020
  • Author: Richard S Krause, MD; Chief Editor: Erik D Schraga, MD  more...
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Inflammation with swelling in the many flexor tendons in the carpal tunnel area may result in median nerve compression (see Carpal Tunnel Syndrome). Injection in this area has the potential to relieve symptoms by reducing this inflammation. [8] This area should be defined by making a mark on the volar aspect of the wrist along the flexor tendons, on the ulnar side of the long palmar tendon, approximately 2.5 cm proximal to the distal wrist crease.

A 22- to 25-gauge needle may be introduced perpendicular to the skin or at an angle of 30-45º, directed proximally or distally along the course of the tendon. The needle should be introduced about 1.25-2.5 cm, and the area should be injected with 0.5 mL of steroid with 0.5-1 mL of lidocaine. If the needle meets obstruction, or if the patient experiences paresthesias, the needle should be withdrawn and redirected to avoid injection into the body of a tendon or into the median nerve itself.

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