ultrasound guided injection of carpal tunnel · ultrasound guided injection of carpal tunnel aanem...
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Ultrasound Guided Injection of Carpal Tunnel
AANEM Regional Workshop
Phoenix, AZ
August 15, 2015
Anthony Lee, MD
Southwest Spine and Sports
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Overviews
• Anatomy of the wrist
• Ultrasound anatomy
• Injection techniques
• Injection of Salivary Glands
• Botox
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Bones of the Hand
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Transverse View
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Longitudinal view
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Why Ultrasound?
• Few RCTs for median nerve injections
• Short term outcomes
– Yes at 6 weeks
• Long term outcomes
– No
• Minimize Complications
• Accuracy
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Two Approaches
• In-plane (IP)
– Needle lined up and parallel to transducer
– Able to see length of the needle as it approaches
• Out-of-plane (OOP)
– Needle perpendicular to transducer
– Transverse view
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Injection techniques
• Transverse approach in plane
– Radial to ulnar
– Ulnar to radial
• Mark ulnar artery
• Radial to ulnar artery
• Longitudinal in plane
• Out of plane
– Ulnar aspect
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Transverse Injection
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Transverse Approach IP
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Transverse vs Longitudinal
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Precautions
• Vascular
– Color Flow
• Anatomy
– 5mm
• Probe Direction
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Ultrasound for Salivary gland injections
• Botox
• Treatment of sialorrhea (CP, stroke, Parkinson’s)
• 9 Systemic Reviews and 2 RCTs in Parkinson’s
• Lagella et al 2006 was U/S vs non (U/S improved wk 1 vs wk 4 of non)
• 10-100u total, 1-3 sites/gland
• Parotid: 5-50u
• Submandibular : 10-30u
• Duration 1.5-7 months
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Botox for Sialorrhea
• Benefits
– Decreased drooling/amount
– Decreased salivary flow rate
– Less respiratory distress
– Improved QOL
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Adverse Effects
Dry Mouth/Xerostemia
Transitory difficulty swallowing
Facial weakness
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Salivary Gland
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Conclusion
• Anatomy
• Anatomy
• Anatomy
• Orientation