Carpal tunnel steroid injection cpt

  • anti-inflammatory medications, ., non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen
  • steroid injections

    While all of these options may offer some benefit, nighttime splinting and steroid injections are most frequently used in the nonoperative management of carpal tunnel syndrome. According to Dr. Daluiski, steroid injections into the carpal tunnel can be successful as an early treatment for patients who have experienced their symptoms for less than a year. Even in this particular patient population, however, only 40% will experience pain relief for a year following injection. Despite this statistic, however, Dr. Daluiski believes that many patients can benefit from this treatment. “It’s a great temporary solution for those who exhibit no serious denervation and muscle weakness and who require temporary relief,” he explains.

    There are some important points to consider when undergoing steroid injection, stresses Dr. Daluiski. “The downside to this kind of treatment is that the patient could have continued progression of nerve damage even though their symptoms have improved.” He monitors his patients closely and never administers more than two injections. “Three is the magic number, but I usually use less. If a patient has had significant relief from a single injection and has a recurrence of severe pain after several years and still has no evidence of atrophy, I might recommend another injection, but only rarely.”

    He suggests having a regular evaluation (which may include repeat electrodiagnostic studies) 6-12 months after the initial injection to watch for progression of nerve damage.

All of the listed physical exam findings, except for loss of small digit adduction (Wartenberg sign), has been found to be predictive for diagnosing carpal tunnel syndrome.

Szabo et al in a Level 3 study used a regression model to analyze the most predictive factors for correctly diagnosing carpal tunnel syndrome (CTS). Their analysis found that with an abnormal hand diagram, abnormal sensibility by Semmes-Weinstein testing in wrist-neutral position, a positive Durkan's test, and night pain, the probability that carpal tunnel syndrome will be correctly diagnosed is . They found the tests with the highest sensitivity were Durkan's compression test (89%), Semmes-Weinstein testing after Phalen's maneuver (83%), and hand diagram scores (76%). Night pain was a sensitive symptom predictor (96%). The most specific tests were the hand diagram (76%) and Tinel's sign (71%). The authors concluded that the addition of electrodiagnostic tests did not increase the diagnostic power of the combination of these 4 clinical tests, and proceeding with surgical release is appropriate even if the EMG is normal.

Wartenberg sign is persistent abduction and extension of the small digit when a patient is asked to adduct the digits and is seen in cubital tunnel syndrome, but not carpal tunnel syndrome.

Illustration V demonstrate the Durkan's Compression test for carpal tunnel syndrome.

Carpal tunnel steroid injection cpt

carpal tunnel steroid injection cpt


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