II. Indications
-
First Carpometacarpal Joint Osteoarthritis
- Refractory to hand therapy and bracing for 4 to 6 weeks
- Severe pain and inflammation of the First Carpometacarpal Joint
III. Preparation
- Needle: 25 to 27 gauge (1 to 1.5 inch) for injection
- Methylprednisolone: 10 to 20 mg (0.25 to 0.5 ml of 40 mg/ml)
- Lidocaine 1%: 0.5 ml
IV. Technique
- Positioning
- Hand and wrist in neutral position, resting on table against ulnar aspect, with anatomic snuff box up
- Landmarks
- Basal joint space at the anatomic snuff box
- Bounds margins (palpate with thumb in full abduction)
- Abductor pollicis longus
- Extensor pollicis brevis
- Extensor pollicis longus
- Ultrasound guidance (high frequency linear probe in longitudinal axis)
- May also be used for landmark identification and realtime injection guidance
- Images
Lewis (1918) Gray's Anatomy 20th ed (in public domain at Yahoo or BartleBy)
- Injection
- Landmark guidance
- Direct needle at 60 to 90 degrees perpendicular to skin into joint
- Ultrasound guidance (high frequency linear probe in longitudinal access)
- Direct needle out-of plane (transverse to Ultrasound probe) into joint
- Landmark guidance
V. Efficacy
- Ineffective in relieving pain in up to 50% of First Carpometacarpal Joint Osteoarthritis cases
- High recurrence rates within 1-2 years after injection