II. Indications

  1. Digital Flexor Tenosynovitis (Trigger Finger)

III. Preparation

  1. Needle: 27 gauge (1.5 inch)
  2. Corticosteroid
    1. Methylprednisolone: 20 mg or
    2. Celestone Soluspan: 0.5 ml or
    3. Triamcinolone 20 mg
  3. Anesthetic
    1. Lidocaine 1%: 0.5 to 1 ml or
    2. Bupivacaine (Marcaine) 0.25% 0.5 to 1 ml

IV. Technique

  1. Wrist and hand position
    1. Maximally abduct thumb (accentuates abductor tendon)
  2. Injection site
    1. Locate tendon Nodule
    2. Palmar aspect of hand
      1. Between Metacarpal head and distal palmar crease
  3. Needle insertion
    1. Apply antiseptic to skin (e.g. Betadine)
    2. Aim 30 degrees proximally parallel to tendon fibers
    3. Have patient gently flex and extend involved finger
      1. Insert until patient experiences scratchy sensation
        1. Indicates needle is in tendon sheath
        2. Inject here
      2. Withdraw 1-2 mm if needle moves as finger moves
        1. Indicates needle is within tendon
        2. Do not inject here
        3. Continue to withdraw until scratchy sensation
  4. Warning
    1. Do not inject directly into tendon

V. Follow-up

  1. May be repeated up to 4 times at 8 week intervals

VI. References

  1. Greene (2001) Musculoskeletal Care, p. 285
  2. Neustadt in Roberts (1998) Procedures, p. 915-6
  3. Pfenninger (1994) Procedures, Mosby, p. 1036-54
  4. Tallia (2003) Am Fam Physician 67(4):745-50 [PubMed]

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