Scapholunate Joint Injection
Other Names
- Scapholunate Joint Injection
Background
Key Points
- 25 gauge, 1.5 needle is appropriate
- Use the high frequency linear transducer
- Can be performed in-plane or out-of-plane
Anatomy of the Scapholunate Joint
- Composed of the scaphoid, lunate
- Stabilized by the scapholunate ligament
Palpation Guidance vs Ultrasound Guidance
- To date, there are no papers comparing palpation guided and ultrasound guided techniques
- Author commentary: unlikely you can predictably enter joint by palpation guidance
Indications
- Scapholunate Tear
- Consider proliferative agents in partial tear
- Scapholunate Advanced Collapse (SLAC)
Contraindications
- Absolute
- Anaphylaxis to injectates
- Overlying cellulitis, skin lesion or systemic infection
- Relative
- Uncertainty in diagnosis
- 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
- Common ultrasound findings include:
- Cortical irregularities
- Calcifications
- SL Ligament can be evaluated for[4]
- Partial tear: thickening or hypoechogenic signal
- Complete tear: anechoic void
Technique: Short Axis, Out-of-Plane
- Patient position
- Supine or seated
- Arm adducted to side and palm of hand resting directly on table or folded towel.
- Transducer position
- Begin in short-axis plane over Lister’s tubercle
- Advance distally until the scaphoid, lunate, and SL ligament are in view.
- Needle Approach/ Orientation
- Out-of-plane
- Distal-to-proximal
- Needle tilted 30 degrees in the sagittal plane
- Consider: Walk-down technique
- Target
- SL Joint Capsule
- Pearls and Pitfalls
- Generally easier to get into SL joint than in-plane
Technique: Short Axis, In-Plane
- Patient position
- Supine or seated
- Arm adducted to side and palm of hand resting directly on table or folded towel.
- Transducer position
- Begin in short-axis plane over Lister’s tubercle
- Advance distally until the scaphoid, lunate, and SL ligament are in view.
- Needle Approach/ Orientation
- In-Plane
- Radial to Ulnar
- Consider: Stand-off technique
- Target
- SL Joint
- Pearls and Pitfalls
- Ideal approach for using regenerative agents or orthobiologics
- Steep access necessitates standoff technique with gel
Aftercare
- Apply bandage
- No major restrictions in most cases
- Can augment with ice, NSAIDS
Complications
- Intravascular injection
- Nerve injury
- Local trauma
See Also
References
- ↑ Image courtesy of Case courtesy of The Radswiki, Radiopaedia.org, rID: 11913
- ↑ Manske, M. Claire, and Jerry I. Huang. "The quantitative anatomy of the dorsal scapholunate interosseous ligament." Hand 14.1 (2019): 80-85.
- ↑ 3.0 3.1 3.2 3.3 Malanga, Gerard, and Kenneth Mautner. Atlas of ultrasound-guided musculoskeletal injections. McGraw-Hill, 2014.
- ↑ Jacobson JA. Wrist and hand ultrasound. In: Jacobson JA, ed. Fundamentals of Musculoskeletal Ultrasound. Philadelphia, PA: Saunders Elsevier; 2007:144–147.
Created by:
John Kiel on 19 December 2023 18:42:09
Authors:
Last edited:
27 December 2023 22:54:51
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