Interphalangeal Joints Injection
Other Names
- Interphalangeal Joints Injection of the hand
- DIPJ injection
- PIPJ injection
- Proximal Interphalangeal Joint Injection
- Distal Interphalangeal Joint Injection
Background
Key Points
- Needle: 25- to 30- gauge
- Transducer: High frequency, linear
- Small joints, can be difficult to access with significant arthritic changes
- Dorsal approach with flexion can provide better access to joint
Anatomy of the Interphalangeal Joints
- Represent the two distal hinges of the fingers.
- DIP joint connects distal phalanx to middle phalanx
- PIP joint connects middle phalanx to proximal phalanx
- Stabilized by the collateral ligaments, dorsal extensor and volar flexor ligament complex
Palpation Guidance vs Ultrasound Guidance
- Success rate without ultrasound varies from 15-32% in one study[1]
- Raza et al: Ultrasound guidance increases accuracy of needle placement (59% vs 96%) and aspiration (0% vs 63%)[2]
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
Equipment
- Sterile including chloraprep, chlorhexadine, 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
- Best visualized in long axis using a high frequency, linear transducer
- Place over the IPJ in long axis
- Can also evaluate in short axis
Technique: Long Axis, Out of Plane
- Patient position
- Supine or seated
- Palm down with dorsal finger exposed
- Towel or rolled object in hand for the patient to grip
- Transducer position
- Long axis to joint
- Needle Approach/ Orientation
- Out of plane
- Target
- Interphalangeal Joint Capsule
- Pearls and Pitfalls
- Color doppler can be used to avoid the digital nerves and arteries
Technique: Long Axis, In Plane
- Patient position
- Supine or seated
- Palm down with dorsal finger exposed
- Towel or rolled object in hand for the patient to grip
- Transducer position
- Long axis to joint
- Needle Approach/ Orientation
- In plane
- Target
- Interphalangeal Joint Capsule
- Pearls and Pitfalls
- Color doppler can be used to avoid the digital nerves and arteries
Aftercare
- No significant restrictions
- Can augment with ice, NSAIDS
- Consider placement in a Thumb Spica Splint
Complications
- Skin: Subcutaneus fat atrophy, skin atrophy, skin depigmentation
- Painful local reaction
- Infection
- Hyperglycmia
- Tendon, nerve or blood vessel injury
See Also
References
- ↑ Pichler W, Grechenig W, Grechenig S, et al. Frequency of successful intra-articular puncture of finger joints: influence of puncture position and physician experience. Rheumatology. 2008;47: 1503–1505.
- ↑ Raza K, Lee CY, Pilling D, et al. Ultrasound guidance allows accurate needle placement and aspiration from small joints in patients with early inflammatory arthritis. Rheumatology. (Oxford) 2003;42:976–979.
- ↑ 3.0 3.1 3.2 3.3 Malanga, Gerard, and Kenneth Mautner. Atlas of ultrasound-guided musculoskeletal injections. McGraw-Hill, 2014.
Created by:
John Kiel on 1 February 2024 16:23:59
Authors:
Last edited:
6 February 2024 17:02:38
Category: