Disclosures: David T. Burke, MD: Nothing to disclose

Case Description: The patient presented to the clinic with symptoms of CTS. She was injected with ½ cc of Kenalog 40 mg per mL to the roof of the carpal tunnel just distal to the proximal crease, in line with the ring finger digit.

Setting: Outpatient rehabilitation clinic

Patient: 43-year-old female patient with a history of complex regional pain syndrome and a diagnosis of carpal tunnel syndrome (CTS).

Assessment/Results: Within 5 minutes, the lateral 3-1/2 digits demonstrating a distinctly different color than the medial 1-1/2 digits. Oxygen saturation was measured and found to be 92% in the index finger and 96% in the little finger. Oxygen saturation was then measured on the contralateral hand and was measured at 97% in the index and little finger.

Discussion: Among symptoms reported by those with CTS is a subjective sense of swelling of the hand. George Phalen, in 1966 commented that, since the median nerve carries with it most of the sympathetic nerve supply of the hand, it would seem logical to anticipate vasomotor changes with irritation of this nerve. This study demonstrates vascular reaction to a carpal tunnel injection that illustrates this asymmetric ANS response.

Conclusion: This case provides a dramatic illustration of an autonomic reaction, isolated to the distribution of the median nerve, in a patient with CTS who had just received a steroid injection into the tunnel, which resulted in skin color changes and oxygen saturation changes that were separate in the median and ulnar distribution of the same hand.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/acute-autonomic-dysfunction-after-carpal-tunnel-syndrome-infection-case-report/