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Second Dorsal Compartment of Wrist Injection

From WikiSM

Other Names

  • Second Dorsal Compartment Injection

Background

[1]

Key Points

  • Needle: Use a 25 gauge, 1-1.5 inch needle
  • Transducer: high frequency, linear
  • Compartment is radial to Lister's tubercle
  • Preferred technique: Short axis, in plane

Anatomy of Second 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

Probe and needle position for short axis, in plane technique[2]
Ultrasound demonstration of needle trajectory for short axis, in plane[2]
Needle and probe position for short axis, out of plane technique[2]
Ultrasound demonstration of needle trajectory for short axis, out of plane technique[2]

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 short axis
  • Use a high frequency linear probe
  • Common ultrasound findings include:
    • Peritendinous fluid
    • Tendon thickening
    • Intrasubstance tears

Technique: Short Axis, In Plane

  • Patient position
    • Seated
    • Arm resting on table
    • Wrist in pronation
  • Transducer position
    • Short axis to the second extensor compartment
  • Needle Approach/ Orientation
    • In plane
    • Lateral to medial or medial to lateral
  • Target
    • Tendon sheath of ECRL, ERCB
  • Pearls and Pitfalls
    • Identify the location of the tendonitis
    • Pre-scan for vessels to avoid

Technique: Short Axis, Out of Plane

  • Patient position
    • Seated
    • Arm resting on table
    • Wrist in pronation
  • Transducer position
    • Short axis to the second extensor compartment
  • Needle Approach/ Orientation
    • Out of plane
    • Distal to Proximal
  • Target
    • Tendon sheath of ECRL, ERCB
  • Pearls and Pitfalls
    • Identify the location of the tendonitis
    • Pre-scan for vessels to avoid
    • More difficult to visualize needle tip with this technique

Aftercare

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

Complications

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

See Also

References

  1. ↑ Kushal, R., et al. "MEng/De Quervain's disease." Eplasty 13 (2013): 52.
  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 9 April 2024 15:09:53
Authors:
Last edited:
30 April 2024 16:30:37
Category:
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