CTS from injury and nervous about steroid injection

There is quite a lot of anatomical variation in the exact position of the nerve and it moves as you move the wrist and fingers anyway. In 6-8% of the population the median nerve has already divided into two branches by the time it gets to the wrist. Injecting close to or through the flexor carpi radialis tendon seems to be the safest anatomically guided approach. The distribution of symptoms in the palm is irrelevant and in fact in CTS sensation in the palm should in theory be normal because the palmar branch leaves the median nerve proximal to the carpal tunnel. If you are worried then ultrasound guidance can help but the risk of intraneural injection is very low even without it as long as the injection is done by someone competent. JB

Thanks for the response.

How bad exactly would it be to receive an inadvertent injection directly into the median nerve? For example 40mg of Kenalog. Would the nerve be able to recover?

I've deleted the duplicate posting. Intraneural injections are very painful but there is very little hard evidence as to what the long-term consequences are - just a handful of anecdotal case reports. We think we have probably identified about 20 or so cases over the years, most of which seem to have suffered no serious long term consequences. JB

Thanks, that's somewhat of a relief! Would the intraneural injection you refer to be one where the steroid has been administered into the nerve or simply where the nerve has been struck by the needle without any administering of the steroid?

That's when the steroid preparation in inadvertently injected into the nerve itself. Just sticking a needle in the nerve will usually not cause too much damage though I have seen a case where one bundle of nerve fibres within the median nerve was probably cut during an episode like that, producing a partial nerve injury. JB

This is a bit of strange one but I used to ice my wrist to help with the CTS and often I'd get a tingly sensation on my skin from the cold when I held it a little too long. Happened on a couple of occasions so I looked into it and apparently it was something called "frostnip" or first degree frostbite. Apparently there's no lasting damage and that does seem to be the case but I do notice that sometimes when I stretch my wrist, I still get the shallow tingly sensation (not CTS-related) in the volar / medial side of my wrist, almost exactly where I'm due to have the anti-inflammatory steroid injected.

I just assumed that it's a bit of residual skin irritation from the icing a couple of weeks ago, and that it will eventually pass - but I'm slightly reticent about injecting an anti-inflammatory directly at the site while the skin is still irritated from the cold. Would you suggest that I bring it up with my consultant?

Thanks!

Edit: Spelling correction

No harm in mentioning it but it's probably not a contraindication to injection. You can get skin depigmentation and subcutaneous fat atrophy after injection for CTS - relatively minor cosmetic issues but if you are sensitive about the appearance of the wrist it's worth knowing about. JB