Comparison of Comfort and Patient Preference of Common and a Novel Position for Ultrasound-Guided Carpal Tunnel Injections

Objectives: This study compared levels of discomfort among three positions for ultrasound-guided carpal tunnel injections (USCTI) to potentially facilitate and improve the procedure's tolerability in treating carpal tunnel syndrome (CTS). Methods: Ambulatory Veterans referred for electromyography (EMG) evaluation of CTS were eligible for the study; a total of 30 participants were evaluated. Participants were asked to hold three different positions: 1) Hypersupination, 2) Airplane, and 3) total supported abduction (TSA). Participants rated their pain level, ease of performing/holding each position, exacerbation of underlying symptoms, and position preference. Results were analyzed with two-way repeated measures ANOVA. Results: Hypersupination was determined to be the least preferred and most painful position to hold, demonstrating a statistically significant increase in the Numeric Rating Scale score for pain during the procedure compared with Airplane and TSA, which were not significantly different from one another. Pre-procedure neck, shoulder, elbow, and wrist pain were not significantly associated with intra-procedure pain. Conclusions: When performing USCTI, patient comfort can be optimized by avoiding Hypersupination. Utilizing the Airplane or TSA positions may provide similar access for ulnar approach injections while inducing lower levels of discomfort. Clinical space, resources, patient mobility, and laterality of procedures may further guide one's selection among the positions.