Brault, Jeffrey S.

ObjectivesCorticosteroid injections can provide (temporary) relief in patients with mild to moderate carpal tunnel syndrome (CTS). Hydrodissection as part of an injection has been associated with positive clinical outcomes but data for CTS so far has been scarce. This study is designed to assess patient tolerance and secondarily provide pilot data on the added effect of hydrodissection.MethodsTwenty CTS patients were randomized to an ultrasound‐guided betamethasone injection with hydrodissection (5 mL) or without (2 mL). Patient tolerance was assessed directly after intervention and patient‐reported outcome after 4 and 24 weeks. Intra‐group data were compared using Wilcoxon Signed Rank and inter‐group with Wilcoxon rank‐sum tests.ResultsTolerance and pain scores did not differ between the two groups. Symptom scores decreased in both groups, but to a lesser extent in the hydrodissection group with a mean difference of −0.8 versus −1.5 in the control group at 4 weeks (P = .02). At 6 months, this difference was no longer present (P = .81). No statistically significant differences were found between the hydrodissection and control groups in the function or pain scores at follow‐up at either time point.ConclusionAfter injection, both symptomatic and functional scores improved, but the hydrodissected group did not show additional improvement. Data presented can be used to support larger studies to assess the value of hydrodissection in CTS management.

Background We report the use of botulinum toxin to aid in the treatment of chronic radial collateral ligament insufficiency of the thumb. Case Description Treatment included autograft tendon reconstruction and cast immobilization. Six weeks postoperatively, prior to hand therapy, the patient underwent an ultrasound-guided botulinum neurotoxin A injection into the adductor pollicis muscle to negate its deforming forces on the reconstruction. The patient made an excellent recovery and 1 year postoperatively was pain free and had a stable radial collateral ligament (RCL) upon examination. Literature Review The outcomes of RCL repair and reconstruction are unpredictable, in part, due to the strong opposing forces of the adductor pollicis. Clinical Relevance The use of Botox injection may enhance the outcomes of RCL repair or reconstruction by neutralizing the deforming forces of the adductor muscle.

Acute calcific tendinitis (ACT) is a relatively uncommon disorder of the hand and wrist. ACT is a well-known condition of the shoulder, but it often goes unrecognized when occurring in the hand or wrist. The overall lack of familiarity along with the non-specific symptoms associated with ACT frequently leads to misdiagnosis or delay in diagnosis. We report a case of acute calcific tendinitis occurring in the carpal tunnel which is a rare presentation.