Syringe

Wrist and Hand Injections

Carpal Tunnel Injection

My Usual Injection

  • 3mL or 5mL syringe

  • 25g 1/2 inch needle

  • 2mL 1% lidocaine

  • 1mL/6mg betamethasone (Celestone)

Procedure

  1. Obtain and document, at least, verbal consent for procedure

  2. Have patient seated with hand resting on a table or pillow in their lap, with the palm up

  3. Identify the injection site

    • If palmaris longus tendon is present, this will be approximately 1cm to the ulnar side of the tendon and 1cm proximal to the flexor crease of the wrist

    • If palmaris longus is not present, this will be approximately 1cm proximal to the flexor crease of the wrist and in line with the ring finger

  4. Mark with a surgical skin marker

  5. Apply gloves

  6. Apply topical antibacterial x 3 

  7. Apply analgesic, if desired (I use ethyl chloride)

  8. Have the patient close their hand into a loose fist

  9. At an approximate 30° angle, aiming toward the ring finger, slowly and controlled insert the needle 1cm

  10. Have the patient open the hand.  This should passively pull the needle into the carpal tunnel.

  11. Gently pull back on the plunger to ensure no vascular entry

  12. Inject slowly

  13. Withdraw needle

  14. Wipe clean

  15. Apply bandage

DeQuervain's Tenosynovitis Injection

  1. Obtain and document, at least, verbal consent for procedure

  2. Have patient seated with hand resting on a table or pillow in their lap

  3. Identify the injection site on the radial styloid at the abductor pollicis longus and ​extensor pollicis brevis tendons

  4. Mark with a surgical skin marker

  5. Apply gloves

  6. Apply topical antibacterial x 3

  7. Apply analgesic, if desired (I use ethyl chloride)

  8. At an approximate 30-45° angle, aiming proximally, slowly and controlled insert the needle to the tendons

  9. Apply light pressure to the plunger while slowly pulling the needle back until the medication can flows easily without resistance

  10. Withdraw needle

  11. Wipe clean

  12. Apply bandage

Trigger Finger Injection

  1. Obtain and document, at least, verbal consent for procedure

  2. Have patient seated with hand resting on a table or pillow in their lap

  3. Palpate the affected flexor tendon and Identify the injection site at the A1 pulley, just distal to the distal palmar flexor crease (you can normally palpate a flexor tendon nodule there)

  4. Mark with a surgical skin marker

  5. Apply gloves

  6. Apply topical antibacterial x 3

  7. Apply analgesic, if desired (I use ethyl chloride)

  8. Slowly and controlled insert the needle to the tendon.  For confirmation that the needle is not in the tendon substance have the patient wiggle the finger.  If the needle is in the tendon the needle will move.  If it is in the sheath you should feel the needle scratch the tendon.

  9. Apply light pressure to the plunger and inject if there is no resistance.  If there is resistance apply light pressure to the plunger while slowly pulling the needle back until the medication can flows easily without resistance.  I like to keep the tip of my index and middle finger on either side if the tendon nodule because you can feel the tendon sheath fill with the injection.

  10. Withdraw needle

  11. Wipe clean

  12. Apply bandage

Thumb CMC Joint Injection

  1. Obtain and document, at least, verbal consent for procedure

  2. Have patient seated with hand resting on a table or pillow in their lap

  3. Identify the injection site by palpating the small step-off or space at the base of the thumb metacarpal.  Sometimes this is easier to palpate if the patient places his/her thumb in the palm.

  4. Mark with a surgical skin marker

  5. Apply gloves

  6. Apply topical antibacterial x 3

  7. Apply analgesic, if desired (I use ethyl chloride)

  8. Slowly and controlled insert the needle at the marked site.  If you hit bone, pull the needle back and redirect the tip toward the joint space. 

  9. Once in the joint space, slowly inject

  10. Withdraw needle

  11. Wipe clean

  12. Apply bandage

Radiocarpal Joint Injection

  1. Obtain and document, at least, verbal consent for procedure

  2. Have patient seated with hand resting on a table or pillow in their lap

  3. Identify the injection site by palpating the small step-off or space just distal to the end of the radius, dorsally  

  4. Mark with a surgical skin marker

  5. Apply gloves

  6. Apply topical antibacterial x 3

  7. Apply analgesic, if desired (I use ethyl chloride)

  8. Slowly and controlled insert the needle at the marked site.  If you hit bone, pull the needle back and redirect the tip toward the joint space. 

  9. Once in the joint space, slowly inject

  10. Withdraw needle

  11. Wipe clean

  12. Apply bandage

Ulnacarpal Joint Injection

  1. Obtain and document, at least, verbal consent for procedure

  2. Have patient seated with hand resting on a table or pillow in their lap

  3. Identify the injection site by palpating the small step-off or space just distal to the end of the ulna, dorsally

  4. Mark with a surgical skin marker

  5. Apply gloves

  6. Apply topical antibacterial x 3

  7. Apply analgesic, if desired (I use ethyl chloride)

  8.  Slowly and controlled insert the needle at the marked site.  If you hit bone, pull the needle back and redirect the tip toward the joint space. 

  9. Once in the joint space slowly inject

  10. Withdraw needle

  11. Wipe clean

  12. Apply bandage