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Wrist Injection

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Other Names

  • Wrist Joint Injection
  • Radioulnar Joint Injection
  • Radiocarpal Joint Arthrocentesis
  • Ulnocarpal Joint Aspiration
  • Wrist Joint Arthrocentesis
  • TFCC Injection

Background

Articular surfaces of the wrist joint[1]
  • This page refers to injections of the wrist joint, this includes both the radiocarpal and ulnocarpal joint
    • This includes both injection and aspiration as the technique and approach are the same

Anatomy


Aspiration

Indications

  • Rule out Septic Arthritis
  • Diagnose Gout or other spondyloarthropathy
  • Symptomatic relief
  • Unexplained joint effusion or monoarthritis

Contraindications

  • Absolute
    • No absolute contraindications
  • Relative
    • Abnormal or altered anatomy
    • Overlying infection or bacteremia
    • Coagulation
    • Prosthetic joint
    • Uncooperative patient
    • Diagnosis can be made with less invasive method

Injection

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

Palpation guided radiocarpal injection[2]
Radiocarpal joint injection in plane, short axis. The needle (arrowheads) is passed radial to extensor compartment four. EDC, extensor digitorum, compartment four; ECRB, extensor carpi radialis brevis tendon; Lun, lunate; Sca, scaphoid.[3]
The radiocarpal joint transducer position and normal appearance under ultrasound[4]

Equipment

  • Sterile including chloraprep, chlorhexadine, iodine
  • Ultrasound with sterile probe cover
  • Gloves
  • Needle: typically 25 gauge, 0.5-1 inch
  • Syringe: 1-3 mL
  • Gauze
  • Ethyl Chloride
  • Bandage
  • Injectate
    • Local anesthetic
    • Corticosteroid

Preparation

  • Position
    • The patient can lay supine or sit upright
    • Arm is in extension, palm is pronated
    • Wrist should be in mild flexion, typically resting on a towel roll

Radiocarpal Palpation Guided

  • Identify the radiocarpal joint space
    • Area of injection is distal to radius between the thumb and index finger extensor tendons
  • Mark site, sterile prep area
  • Injection
    • Optional: local anesthetic in skin and subcutaneous tissue
    • Advance needle into joint space perpendicular to the skin
    • If bone is hit, pull back and slightly redirect distally
    • Once the needle drops into the radiocarpal space, injection/ aspiration can occur

Ulnocarpal Palpation Guided

  • Dorsal approach: Identify the ulnocarpal joint space
    • Area of injection is just distal to ulnar styloid between the fourth and fifth extensor tendons
  • Mark site, sterile prep area
  • Injection
    • Optional: local anesthetic in skin and subcutaneous tissue
    • Advance needle into joint space perpendicular to the skin
    • If bone is hit, pull back and slightly redirect distally
    • Once the needle drops into the ulnocarpal space, injection/ aspiration can occur
  • Alternative medial approach
    • Needle is inserted into the depression distal and slightly palmar to the ulnar styloid
    • Angle 10° to 15° in a cephalad direction

Ultrasound Guided Technique

  • Pre-procedure ultrasound evaluation
    • Identify either the radiocarpal or ulnocarpal joint dorsally in long axis
    • For the radiocarpal joint, orient from listers tubercle on the radius
    • The proximal and distal bones should be evaluated for optimal needle approach
    • Wrist flexion can be adjusted to optimize approach
    • It is important to identify a tendon-free region for the needle to transverse
  • In-Plane Approach
    • Transducer is maintained in a long axis view
    • Needle approach is typically distal-to-proximal
  • Out-of-Plane Approach
    • Transducer remains in long axis
    • Follow needle into space in a step-wise approach

Aftercare

  • Apply bandage
  • No major restrictions in most cases
  • Can augment with ice, NSAIDS

Complications

  • Pain
  • Infection
  • Recurrence of effusion
  • Damage to surrounding soft tissue structures

See Also


References

  1. Image courtesy of teachmeanatomy.info, "Structures of the Wrist Joint
  2. Image courtesy of rheumatologynetwork.com, "Injection of the wrist and ulnar styloid
  3. Na, Kyoung-Sun. "Ultrasound-guided intra-articular injections." The Korean Journal of Medicine 89.6 (2015): 654-662.
  4. Image courtesy of acepnow.com, "Easy Ultrasound Technique to Evaluate and Aspirate an Atraumatic Painful Wrist"
Created by:
John Kiel on 27 January 2023 07:54:57
Authors:
Last edited:
2 December 2023 16:23:15
Category: