Dupuytren's Nodule Corticosteroid Injection

Aka: Dupuytren's Nodule Corticosteroid Injection

1. Indications
   1. Grade 1 Dupuytren's Disease (Nodule present)
2. Preparation
   1. Needle: 27 gauge (1.5 inch)
   2. Corticosteroid
      1. Triamcinolone Acetonide 20 mg or
      2. Methylprednisolone: 20 mg or
      3. Celestone Soluspan: 0.5 ml
   3. Anesthetic
      1. Lidocaine 1%: 0.5 to 1 ml
3. Technique
   1. Wrist and hand position
      1. Relaxed hand position with wrist supinated
   2. Injection site
      1. Locate Dupuytren's Nodule
   3. Needle insertion
      1. Apply antiseptic to skin (e.g. Betadine)
      2. Consider bending needle 45 degrees
      3. Inject directly into Nodule
         1. Parallel to plane of hand
         2. Approach from each position of a 5-point star
            1. Top: 12 o'clock
            2. Sides: 3 and 9 o'clock
            3. Inferiorly: 5 and 7 o'clock
4. Follow-up
   1. Consider injecting q4-6 weeks for 3-5 injections
   2. Consider a 6 month hiatus and then restart cycle
5. Complications
   1. Local tenderness at injection site
   2. Depigmentation or atrophy at injection site
   3. Flexor tendon rupture
6. Efficacy
   1. Improves hand function and reduces Nodule size
   2. Significant decrease in those needing surgery
7. References
   1. Ketchum (2000) J Hand Surg 25:1157-62 [PubMed]
   2. Trojian (2007) Am Fam Physician 76:86-90 [PubMed]