Efficacy of ultrasound-guided perineural injections of the median nerve: A systematic review
Lindsey Kim1, Chaitanya Konda1, Eric Jones2, Levent Özçakar3
, Nitin B. Jain4
1Department of Physical Medicine and Rehabilitation, The University of Texas Southwestern, Dallas, TX, USA
2Department of Physical Medicine and Rehabilitation, Icahn School of Medicine at Mount Sinai, New York, NY, USA
3Department of Physical Medicine and Rehabilitation, Hacettepe University Faculty of Medicine, Türkiye
4Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
Keywords: Anatomic landmarks, median nerve injection, median neuropathy, ultrasound-guided.
Abstract
Objectives: In this review, we discuss the efficacy of ultrasound (US)-guided versus landmark (LM)-guided median perineurial nerve injections in carpal tunnel syndrome (CTS).
Materials and methods: Initial search of PubMed, Scopus, Web of Science, and Emboss databases using search terms such as “median neuropathy,” “ultrasound-guided,” and “median nerve injection” from October 1966 to May 2023 yielded 4,172 articles to be screened by one reviewer for eligibility and two reviewers for full-text review. The study quality of the resulting 12 articles was assessed using the Newcastle-Ottawa Scale (NOS) and Revised Cochrane Risk of Bias Tool of Randomized Trials (RoB 2).
Results: All 12 articles reviewed evaluated efficacy of US-guided injections relative to LM-guided injections. Nine studies showed improved outcomes in US-guided injections compared to LM-guided, including improvement in the Boston Carpal Tunnel Syndrome Symptom Severity Scale and Functional Status Scale and improvement in procedural pain and injection pain.
Conclusion: Both US-guided and LM-guided median perineurial nerve injections can improve outcomes in patients with CTS. However, further studies are warranted to assess the accuracy of US-guided median perineurial nerve injections compared to LM-guided to effectively conclude whether one technique is superior to the other.
Citation:
Kim L, Konda C, Jones E, Özçakar L, Jain NB. Efficacy of ultrasound-guided perineural injections of the median nerve: A systematic review. Arch ISPRM 2026;1(1):11-21. https:// doi.org/10.5606/archisprm.2026.32.
N.B.J., L.O.: Idea/concept, design, control/supervision; L.K.: Data collection and/or processing; L.K., C.K., N.B.J., L.O.: Analysis and/or interpretation; L.K., C.K., E.J.: Literature review, writing the article; L.K., C.K., E.J., L.O.: Critical review.
The authors declare that there are no conflicts of interest with respect to the research, authorship, and/or publication of this article.
This research received no specific grant from any funding agency in the public, commercial, or not‑for‑profit sectors.
Data Availability
The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.
AI Disclosure
The authors declare that artificial intelligence (AI) tools were not used, or were used solely for language editing, and had no role in data analysis, interpretation, or the formulation of conclusions. All scientific content, data interpretation, and conclusions are the sole responsibility of the authors. The authors further confirm that AI tools were not used to generate, fabricate, or ‘hallucinate’ references, and that all references have been carefully verified for accuracy.