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Sixth Dorsal Compartment of the Wrist Injection

From WikiSM

Other Names

  • Sixth Dorsal Compartment of the Wrist Injection
  • Sixth Extensor Compartment of the Wrist Injection
The extensor compartments of the wrist[1]
The injection into the ECU tendon sheath is performed well proximal to the wrist and DRUJ to prevent accidental injection into these joints[2]

Background

Key Points

  • Needle: 25 gauge, 1.5 inch
  • Transducer: high frequency, linear
  • A gel step off may be required
  • Avoid the ulnar styloid when injecting

Anatomy of the Sixth 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

Short axis in plane needle and probe position[3]
Ultrasound view of short axis in plane approach[3]
Long axis in plane needle and probe position[3]
Ultrasound view of long axis in plane approach[3]

Equipment

  • Sterile prep (i.e. chloraprep, chlorhexidine, iodine, etc)
  • 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 viewed in short axis
  • Find the ulnar styloid in short axis and slide slightly lateral
  • Common ultrasound findings include:

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
  • Target
    • ECU Tendon sheath
  • Pearls and Pitfalls
    • Keep wrist pronated to maintain ECU in groove
    • Can bend the needle at the hub
    • Avoid ulnar styloid

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
    • ECU Tendon sheath
  • Pearls and Pitfalls
    • Useful if short axis approach is technically difficult

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. ↑ Ruland, Robert T., and Christopher J. Hogan. "The ECU synergy test: an aid to diagnose ECU tendonitis." The Journal of hand surgery 33.10 (2008): 1777-1782.
  3. ↑ 3.0 3.1 3.2 3.3 Malanga, Gerard A., and Kenneth R. Mautner. "Atlas of ultrasound-guided musculoskeletal injections." (No Title) (2014).
Created by:
John Kiel on 18 June 2024 12:35:12
Authors:
Last edited:
7 October 2025 00:04:17
Category:
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