Ultrasound guided wrist and hand injections

Injections of the carpometacarpal joint are often less painful under ultrasound guidance and very effective. As with all techniques, patient positioning and comfort are key as you start to develop a standardised approach to performing this procedure. Hopefully you find the resources below helpful.

 

Ultrasound guided injections of the 1st extensor compartment ensure correct steroid placement, and this is particularly important when there are two separate compartments for the APL and EPB tendons. This is also a common area for patients to experience subcutaneous fat atrophy and skin depigmentation with steroid injections so accurate placement of the needle can assist reducing this risk.

 

Trigger fingers can be very disabling and painful, and steroid injections tend to provide effective management. Here we outline how we approach this under ultrasound guidance. as with any technique, ensuring you keep your probe stationary in a long axis view of the flexor tendons whilst injecting is vital to ensure continuous needle visualisation. These tendons are not often that wide, so subtle movements either way can mean you will no longer see the needle.

This technique is straightforwards and best performed with the patients forearm in pronation, over a bowl to allow the joint to flex slightly. Moving the wrist joint from flexion to extension can also help to visualise the joint recess before injecting. Utilise the landmark of Listers tubercle to standardise the approach you will take each time.

 

Injections of the carpal tunnel under ultrasound guidance can be technically challenging due to anatomical variations of the position of neurovascular structures. We tend to advocate a radial approach.