Wrist Injection Technique

Wrist Injection with steroid is a theraputic option for Acute or chronic capsulitis of the wrist jointl, this may result from overuse or trauma.

Equipment Needed

• Syringe: 2 ml
• Needle: Blue, 23 gauge, 1.25 inches (30 mm)
• Kenalog 40: 20 mg
• Lidocaine: 1.5 ml, 2%
• Total volume: 2 ml

Related Anatomy

The wrist joint capsule is not continuous and has septa dividing it into separate compartments. For this reason, it cannot be successfully injected at one spot but usually requires several areas of infiltration through one injection entry point.

See Also: Wrist Anatomy

Wrist Injection Technique

• Patient places hand palm down in some degree of wrist flexion
• Identify midcarpus proximal to hollow dip of capitate
• Insert needle at midpoint of carpus
• Inject at different points across dorsum of the wrist, both into ligaments and also intracapsular, where possible.

After Wrist Injection, the patient rests in a splint until the pain subsides and then start gentle active and passive mobilizing exercises within the pain-free range. Simple wax baths can be most beneficial, and the wax can be used as an exercise ball after being peeled off the hands. Heavy hand work should be curtailed.

Note

This is a common area for wrist injection in patients with rheumatoid arthritis. If the joint is badly affected and swollen, it might be necessary to use a longer needle to reach all around the area or to inject at several points. Patients suffering from trauma, overuse or OA usually respond well to a short period of pain-relieving medication and rest in a splint. As in all cases of trauma, fracture, especially of the scaphoid, should be eliminated.

Distal Radioulnar Joint Injection

Distal Radioulnar Joint Injection with steroid is used for Chronic capsulitis or acute tear of the meniscus.

Equipment Needed

• Syringe: 2 ml
• Needle: Orange, 25 gauge, 0.5 inch (16 mm)
• Kenalog 40: 10 mg
• Lidocaine: 1 ml, 2%
• Total volume: 1.25 ml

Related Anatomy

The inferior radioulnar joint is an L-shaped joint about a finger’s width in length and includes a triangular cartilage, which separates the ulna from the carpus. With the palm facing downwards, the joint line lies just medial to the bump of the end of the ulna, one-third across the wrist. The joint line is identified by gliding the ends of the radius and ulna against each other or by palpating the space between the styloid process of the ulna and the triquetral.

Distal Radioulnar Joint Injection Technique

• Patient sits with hand palm down
• Identify styloid process of ulnar
• Insert needle just distal to styloid, aiming transversely towards radius and passing through ulnar collateral ligament to penetrate capsule
• Inject solution as a bolus.

Advise rest for about a week, with avoidance of flexion and ulnar deviation activities. Mobilization with distraction can be effective in meniscal tears.

Note

Tears of the cartilage are relatively common, especially after trauma, such as falling on the outstretched hand, a traction injury or after Colles’ fracture. The most pain-provoking test is the scoop test – compressing the supinated wrist into ulnar deviation and scooping it in a semicircular movement towards flexion. The patient often complains of painful clicking and occasionally the wrist locks.

Mobilization of the radioulnar joint can help relieve pain, but an injection, together with taping or splinting, may be given in the acute phase. Often, an explanation of the condition and reassurance, together with advice on avoidance of impingement movements, such as turning a heavy steering wheel, doing handstands or a poor golf style, is sufficient.

Distal radioulnar joint (DRUJ) disorders are uncommon but important causes of ulnar-sided wrist pain and disability. Fluoroscopically guided injections may be performed to diagnose or treat DRUJ-related pain or as part of a diagnostic arthrogram. Sonographic guidance may provide a favorable alternative to fluoroscopic guidance for distal DRUJ injections.

In a a randomized, prospective single-blinded study for palpation versus ultrasound-guided corticosteroid injections and short-term effect in the distal radioulnar joint disorder, this study found that there was no significant difference in clinical outcomes between the group receiving US-guided Distal Radioulnar Joint Injections and the group receiving palpation-guided injections. US-guided IA injection showed significantly higher accuracy than palpation-guided IA injection in the DRUJ, and corticosteroid IA injections were effective in improving of the pain of patients with DRUJ disorder during 6 months of follow-up.

References

1. Urits I, Smoots D, Anantuni L, Bandi P, Bring K, Berger AA, Kassem H, Ngo AL, Abd-Elsayed A, Manchikanti L, Urman R, Kaye AD, Viswanath O. Injection Techniques for Common Chronic Pain Conditions of the Hand: A Comprehensive Review. Pain Ther. 2020 Jun;9(1):129-142. doi: 10.1007/s40122-020-00158-4. Epub 2020 Feb 25. Erratum in: Pain Ther. 2020 Mar 31;: PMID: 32100225; PMCID: PMC7203307.
2. Smith J, Rizzo M, Sayeed YA, Finnoff JT. Sonographically guided distal radioulnar joint injection: technique and validation in a cadaveric model. J Ultrasound Med. 2011 Nov;30(11):1587-92. doi: 10.7863/jum.2011.30.11.1587. PMID: 22039032.
3. Nam SH, Kim J, Lee JH, Ahn J, Kim YJ, Park Y. Palpation versus ultrasound-guided corticosteroid injections and short-term effect in the distal radioulnar joint disorder: a randomized, prospective single-blinded study. Clin Rheumatol. 2014 Dec;33(12):1807-14. doi: 10.1007/s10067-013-2355-7. Epub 2013 Aug 11. PMID: 23934387.