Ultrasound-Guided, Mid-Forearm Median Nerve Block for Relief of Carpal Tunnel Syndrome Pain in the Emergency Department: A Case Report

Abstract

Introduction

Carpal tunnel syndrome (CTS) is a common complaint in the emergency department (ED) and accounts for approximately 90% of all peripheral neuropathies. ⁶ Pain control from injection with corticosteroids into the carpal tunnel space is associated with multiple possible complications including atrophy, iatrogenic median nerve injury, and skin changes. Ultrasound (US)-guided mid-forearm median nerve block is an ED procedure that can be used to avoid direct injection into the carpal tunnel space. Here we present a case report proposing the use of US-guided mid-forearm block as a safe and effective adjunct to the management of acute pain caused by CTS.

Case Report

A previously healthy 44-year-old, right-hand dominant female presented to the ED with left wrist pain. Her clinical exam and US findings were consistent with CTS. Given her allergy to non-steroidal anti-inflammatory drugs, she was offered a median nerve block, which was performed in the ED. The patient reported continued pain relief 24 hours after discharge from the ED.

Conclusion

There is limited data on the use of US-guided mid-forearm median nerve block as an acute pain management tool for CTS in the ED. The US-guided median nerve block done in the mid-forearm location can provide pain control for those with CTS while reducing the risk of complications associated with direct carpal tunnel injection.