Ultrasound-Guided Cortisone Injections for Carpal Tunnel Syndrome

 

Introduction

Carpal Tunnel Syndrome (CTS) is one of the most recognised conditions affecting the hand and wrist, often associated with pain, tingling, numbness, or weakness. It arises due to compression of the median nerve as it passes through a narrow passage in the wrist called the carpal tunnel. The symptoms can have a significant effect on daily activities, particularly tasks that require gripping, typing, writing, or fine motor skills.

At Joint Injections, we provide ultrasound-guided cortisone injections for Carpal Tunnel Syndrome. Ultrasound technology allows precise delivery of cortisone into the targeted area, supporting accuracy and comfort during the procedure. This blog provides a detailed overview of Carpal Tunnel Syndrome, its anatomy, pathology, causes, clinical presentation, diagnosis, and management options. It also explains in depth the role of cortisone and the mechanism by which it may assist in managing symptoms.

Anatomy of the Carpal Tunnel

The carpal tunnel is a narrow anatomical passage located at the base of the palm. It is bordered by carpal bones on the bottom and sides, while the top is covered by a thick ligament called the transverse carpal ligament (also known as the flexor retinaculum).

Within this confined tunnel run several vital structures:

  • Median nerve — the main nerve affected in Carpal Tunnel Syndrome.
  • Flexor tendons — nine tendons that help bend the fingers and thumb.

The tight nature of the tunnel means that even small changes, such as swelling or thickening of surrounding structures, can compress the median nerve and lead to symptoms.

Pathology of Carpal Tunnel Syndrome

Carpal Tunnel Syndrome develops when there is increased pressure within the tunnel that compresses the median nerve. This nerve supplies sensation to the thumb, index finger, middle finger, and part of the ring finger, as well as motor control to some of the small muscles of the hand.

Compression of the nerve can impair its function, resulting in sensory disturbances such as numbness or tingling, and motor issues such as weakness or loss of dexterity. Prolonged or severe compression may even cause nerve changes that can take time to improve once the pressure is reduced.

Causes and Risk Factors

Several factors may contribute to the development of Carpal Tunnel Syndrome. While no single cause is always identified, common contributing factors include:

  • Repetitive movements — activities involving frequent use of the hands and wrists, such as typing, manual work, or use of vibrating tools.
  • Wrist anatomy — naturally narrower carpal tunnels may predispose some individuals.
  • Inflammation — swelling of tendons or surrounding tissues, sometimes linked with repetitive strain.
  • Medical conditions — such as diabetes, rheumatoid arthritis, thyroid disease, and pregnancy-related fluid retention.
  • Trauma — wrist fractures or dislocations may alter the anatomy of the tunnel.

Symptoms of Carpal Tunnel Syndrome

Symptoms usually develop gradually and may vary in severity. They often include:

  • Tingling or numbness in the thumb, index, middle, and part of the ring finger.
  • Pain in the wrist or hand, which can sometimes radiate up the arm.
  • Weakness or difficulty gripping objects.
  • Night-time symptoms, often disturbing sleep, as wrist position during rest may exacerbate compression.
  • Difficulty performing tasks requiring fine motor control, such as buttoning clothes or holding small items.

Diagnosis of Carpal Tunnel Syndrome

Diagnosis is based on clinical assessment and, in some cases, additional investigations. Clinicians may use a combination of history, physical examination, and diagnostic tools.

Clinical Examination

  • Phalen’s test — flexing the wrists to see if it triggers symptoms.
  • Tinel’s sign — tapping over the median nerve to elicit tingling.
  • Strength and sensation testing — assessing grip strength and finger sensation.

Diagnostic Imaging and Studies

  • Ultrasound — may demonstrate swelling of the median nerve or other structural changes.
  • Electromyography (EMG) — assesses the electrical activity of muscles supplied by the nerve.

Management of Carpal Tunnel Syndrome

Management depends on the severity of symptoms and the impact on function. Options range from conservative measures to interventional procedures.

Non-Interventional Options

  • Activity modification — adjusting repetitive tasks to reduce strain.
  • Lifestyle adjustments — such as ergonomics at work.

At Joint Injections, cortisone injections for Carpal Tunnel Syndrome are performed under real-time ultrasound guidance. The use of ultrasound provides clear visualisation of the median nerve and surrounding structures, supporting accuracy in needle placement. This precision is particularly important in the wrist, where anatomical structures are compact and sensitive.

Why Ultrasound Guidance Matters

  • Allows direct visualisation of the median nerve.
  • Helps avoid nearby tendons and blood vessels.
  • Supports accurate placement of cortisone in the intended area.

Cortisone and Its Mechanism of Action

Cortisone is a corticosteroid used in injection therapy. It is different from the steroids associated with bodybuilding and has specific applications in medicine. When injected into the carpal tunnel:

  1. Anti-inflammatory effect — Cortisone reduces local inflammation around tendons and tissues that may contribute to pressure within the tunnel.
  2. Reduction of swelling — Decreased swelling may relieve pressure on the median nerve.
  3. Modulation of immune response — Cortisone can influence immune activity, which is relevant in conditions such as rheumatoid arthritis that may contribute to symptoms.

By reducing inflammation and swelling, cortisone may provide an environment in which the median nerve experiences less compression.

Benefits of Ultrasound-Guided Cortisone Injections at Joint Injections

Patients choosing Joint Injections for ultrasound-guided cortisone injections may benefit from:

  • Precision — real-time imaging supports targeted delivery.
  • Experienced clinicians — procedures are carried out by skilled clinicians familiar with musculoskeletal anatomy.
  • Comfort-focused approach — ultrasound reduces the need for repeated needle attempts.
  • Streamlined care — assessment and procedure may be carried out in the same appointment, where suitable

Living with Carpal Tunnel Syndrome

Living with Carpal Tunnel Syndrome can affect work, hobbies, and daily routines. Early recognition of symptoms and timely assessment by a clinician can support management. Ergonomic adaptations, hand exercises, and appropriate interventions can help maintain function.

Why Choose Joint Injections for Carpal Tunnel Syndrome?

At Joint Injections, we focus on providing patient-centred care for those experiencing musculoskeletal and nerve-related conditions. Our use of ultrasound guidance in cortisone injections reflects a commitment to precision and accuracy. Every individual is assessed by a clinician to determine the most suitable approach for their situation.

Conclusion

Carpal Tunnel Syndrome is a common condition caused by compression of the median nerve within the wrist. It can lead to pain, tingling, numbness, and weakness, often interfering with everyday activities. Understanding its anatomy, causes, and management options is important for those affected.

Ultrasound-guided cortisone injections at Joint Injections represent one interventional option for managing symptoms. Cortisone works by reducing inflammation and swelling, thereby potentially easing pressure on the median nerve. With the support of ultrasound technology, the injection can be delivered with accuracy and care.

At Joint Injections, our clinicians are dedicated to providing tailored, precise, and supportive care for individuals with Carpal Tunnel Syndrome.

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