Indications
1. Grade 1 Dupuytren's Disease (Nodule present)
Preparation
1. Needle: 27 gauge (1.5 inch)
2. Corticosteroid
  1. Triamcinolone acetonide 20 mg or
  2. Methylprednisolone: 20 mg or
  3. Celestone Soluspan: 0.5 ml
3. Anesthetic
  1. Lidocaine 1%: 0.5 to 1 ml
Technique
1. Wrist and hand position
  1. Relaxed hand position with wrist supinated
2. Injection site
  1. Locate Dupuytren's Nodule
3. Needle insertion
  1. Apply antiseptic to skin (e.g. Betadine)
  2. Consider bending needle 45 degrees
  3. Inject directly into Nodule
    1. Parallel to plane of hand
    2. Approach from each position of a 5-point star
      1. Top: 12 o'clock
      2. Sides: 3 and 9 o'clock
      3. Inferiorly: 5 and 7 o'clock
Follow-up
1. Consider injecting q4-6 weeks for 3-5 injections
2. Consider a 6 month hiatus and then restart cycle
Complications
1. Local tenderness at injection site
2. Depigmentation or atrophy at injection site
3. Flexor tendon rupture
Efficacy
1. Improves hand function and reduces Nodule size
2. Significant decrease in those needing surgery
References
1. Ketchum (2000) J Hand Surg 25:1157
2. Trojian (2007) Am Fam Physician 76:86

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.