Carpal Tunnel Syndrome: Injections and Alternatives to Surgery
Published on 2026-05-21
Carpal Tunnel Syndrome: When Infiltration Can Avoid Surgery
Carpal tunnel syndrome is the most common compression neuropathy, affecting the median nerve at the wrist level. It manifests as tingling, numbness, and pain in the hand, especially at night. Although surgery is often proposed, ultrasound-guided infiltration offers an effective and minimally invasive alternative.
Understanding Carpal Tunnel Syndrome
The median nerve passes through the carpal tunnel, a rigid space bounded by the carpal bones and the transverse carpal ligament. When pressure increases within this tunnel (inflammation of flexor tendons, water retention, arthritis), the median nerve is compressed, leading to characteristic symptoms.
Symptoms and Diagnosis
- Tingling and numbness of the thumb, index finger, middle finger, and half of the ring finger
- Night pain waking the patient, relieved by shaking the hand ("Flick sign")
- Sensation of a swollen hand or dead fingers upon waking
- At an advanced stage: loss of strength, thenar eminence atrophy, clumsiness
The diagnosis is confirmed by musculoskeletal ultrasound, which measures the cross-sectional area of the median nerve (normal < 9 mm² at the wrist, pathological > 10 mm²) and visualizes signs of nerve distress. Electromyography (EMG) completes the evaluation in doubtful cases.
Ultrasound-Guided Carpal Tunnel Infiltration
Cortisone infiltration under ultrasound guidance is the standard medical treatment for mild to moderate carpal tunnel syndrome. Dr. Bolduc performs this infiltration with a fine needle, under direct visualization, depositing the corticosteroid around the median nerve without damaging it.
Advantages of ultrasound-guided infiltration:
- Precision: the medication is deposited exactly where needed, around the nerve
- Safety: the needle and nerve are visualized in real time, minimizing the risk of nerve injury
- Efficacy: 70 to 80% of patients experience significant improvement
- Speed: the procedure lasts 5 to 10 minutes, no hospitalization required
- Rapid return to activities: possible the same day or the next day
Frequently Asked Questions
How long does the effect of a carpal tunnel infiltration last?
Relief lasts on average 3 to 12 months depending on initial severity. Mild forms respond better and longer. The infiltration can be repeated 1 to 2 times at 3-6 month intervals before considering surgery.
Is ultrasound-guided carpal tunnel infiltration dangerous?
No, it is a safe procedure when performed under ultrasound guidance by an experienced physician. The risk of nerve injury is very low because the needle and nerve are visualized in real time. Complications (infection, hematoma) are rare.
Can I work after a carpal tunnel infiltration?
Yes, most patients return to work the next day. It is advisable to avoid significant gripping efforts and repetitive wrist movements for 24 to 48 hours.
Is infiltration effective for all forms of carpal tunnel syndrome?
Infiltration is most effective for mild to moderate forms. Severe forms with muscle atrophy or permanent sensory deficit respond less well, and surgery is generally recommended from the outset.