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

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.

Point of care ultrasound needle guidance to assist diagnosis of acute gluteal compartment syndrome.

Gluteal compartments can be difficult to assess for acute compartment syndrome (ACS) compared to other fascial compartments due to their anatomy and rarity of presentation. Point-of-care ultrasound (POCUS) needle guidance may assist in obtaining accurate compartment pressure measurements within the gluteal compartments. We present a case in which a 69-year-old woman presented following a fall resulting in a superior prosthetic hip dislocation. One-hour post hip-reduction, the patient began to experience severe pain of the right leg, swelling to the gluteal region, and numbness to her foot. With consideration of a developing gluteal compartment syndrome in mind, POCUS was used to guide the needle of a compartmental pressure monitor system into the gluteal maximus and medius-minimus compartments which demonstrated elevated compartment pressures consistent with ACS. The patient was subsequently taken for emergent fasciotomy and hematoma evacuation. There has been limited investigation into compartment pressure measurement under US guidance versus a palpation/landmark-guided technique. This case shows the feasibility of US needle guidance when assessing compartment pressures for this uncommon diagnosis.