Procedure
Dupuytren's Nodule Corticosteroid Injection
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Dupuytren's Nodule Corticosteroid Injection
See Also
Tendon Sheath Injection
Indications
Grade 1
Dupuytren's Disease
(
Nodule
present)
Preparation
Needle: 27 gauge (1.5 inch)
Corticosteroid
Triamcinolone Acetonide
20 mg or
Methylprednisolone
: 20 mg or
Celestone Soluspan
: 0.5 ml
Anesthetic
Lidocaine
1%: 0.5 to 1 ml
Technique
Wrist
and hand position
Relaxed hand position with wrist supinated
Injection site
Locate Dupuytren's
Nodule
Needle insertion
Apply antiseptic to skin (e.g.
Betadine
)
Consider bending needle 45 degrees
Inject directly into
Nodule
Parallel to plane of hand
Approach from each position of a 5-point star
Top: 12 o'clock
Sides: 3 and 9 o'clock
Inferiorly: 5 and 7 o'clock
Follow-up
Consider injecting q4-6 weeks for 3-5 injections
Consider a 6 month hiatus and then restart cycle
Complications
Local tenderness at injection site
Depigmentation or atrophy at injection site
Flexor tendon rupture
Efficacy
Improves hand function and reduces
Nodule
size
Significant decrease in those needing surgery
References
Ketchum (2000) J Hand Surg 25:1157-62 [PubMed]
Trojian (2007) Am Fam Physician 76:86-90 [PubMed]
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