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Fifth Dorsal Compartment of the Wrist Injection

From WikiSM

Other Names

  • Fifth Dorsal Compartment of the Wrist Injection
  • Fifth Extensor Compartment of the Wrist Injection

Background

The extensor compartments of the wrist[1]

Key Points

  • Needle: 25 gauge, 1.5 inch
  • Transducer: high frequency, linear
  • Avoid the ulnar styloid when injecting

Anatomy of the Fifth Dorsal Compartment

Palpation Guidance vs Ultrasound Guidance

  • It is recommended that this injection be performed with ultrasound guidance
  • There is no literature comparing palpation and ultrasound guidance

Indications

Contraindications

  • Absolute
    • Anaphylaxis to injectates
    • Overlying cellulitis, skin lesion or systemic infection
  • Relative
    • Can be treated with less invasive means
    • Hyperglycemia or poorly controlled diabetes
    • Lack of symptom improvement with previous injection

Procedure

Needle and probe position for short axis, in plane approach[2]
Ultrasound view with needle trajectory for short axis, in plane approach[2]
Needle and probe position for long axis, in plane approach[2]
Ultrasound view with needle trajectory for long axis, in plane approach[2]

Equipment

  • Sterile including chloraprep, chlorhexidine, iodine
  • Gloves
  • Needle: typically 21-25 gauge, 1.5 inch
  • Syringe: 5-10 mL
  • Gauze
  • Ethyl Chloride
  • Bandage
  • Injectate
    • Local anesthetic
    • Corticosteroid
  • Sterile probe cover

Ultrasound Findings

  • Optimal position
    • Hand is pronated, wrist resting on rolled towel in flexion
    • Best seen in short axis

Technique: Short Axis, In-Plane

  • Patient position
    • Seated or supine
    • Forearm pronated and partially flexed on a rolled towel
  • Transducer position
    • Short axis
  • Needle Approach/ Orientation
    • In-plane
    • Ulnar to radial or Radial to ulnar
  • Target
    • Tendon sheath
  • Pearls and Pitfalls
    • May require step off technique
    • Can bend needle at hub to optimize technique

Technique: Long Axis, In-Plane

  • Patient position
    • Seated or supine
    • Forearm pronated and partially flexed on a rolled towel
  • Transducer position
    • Long axis
  • Needle Approach/ Orientation
    • In-plane
  • Distal to proximal
    • Target
    • Tendon sheath
  • Pearls and Pitfalls
    • May require step off technique

Aftercare

  • No significant restrictions
  • Can augment with ice, NSAIDS
  • Consider placement in a Cock Up Wrist Splint

Complications

  • Skin: Subcutaneous fat atrophy, skin atrophy, skin depigmentation
  • Painful local reaction
  • Infection
  • Hyperglycemia
  • Tendon, nerve or blood vessel injury

See Also

References

  1. ↑ Image courtesy of teachmeanatomy.info, "The Extensor Tendon Compartments of the Wrist"
  2. ↑ 2.0 2.1 2.2 2.3 Malanga, Gerard A., and Kenneth R. Mautner. "Atlas of ultrasound-guided musculoskeletal injections." (No Title) (2014).
Created by:
John Kiel on 17 June 2024 17:35:01
Authors:
Last edited:
17 June 2024 18:04:26
Category:
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