Procedure

First Carpometacarpal Joint Steroid Injection

First Carpometacarpal Joint Steroid Injection, Trapeziometacarpal joint Corticosteroid Injection, Thumb Carpometacarpal Joint Injection, Thumb Base Steroid Injection

See Also

Indications

First Carpometacarpal Joint Osteoarthritis
1. Refractory to hand therapy and bracing for 4 to 6 weeks
2. Severe pain and inflammation of the First Carpometacarpal Joint

Preparation

Needle: 25 to 27 gauge (1 to 1.5 inch) for injection
Methylprednisolone: 10 to 20 mg (0.25 to 0.5 ml of 40 mg/ml)
Lidocaine 1%: 0.5 ml

Technique

Positioning
1. Hand and wrist in neutral position, resting on table against ulnar aspect, with anatomic snuff box up
Landmarks
1. Basal joint space at the anatomic snuff box
2. Bounds margins (palpate with thumb in full abduction)
  1. Abductor pollicis longus
  2. Extensor pollicis brevis
  3. Extensor pollicis longus
3. Ultrasound guidance (high frequency linear probe in longitudinal axis)
  1. May also be used for landmark identification and realtime injection guidance
4. Images
  1. Lewis (1918) Gray's Anatomy 20th ed (in public domain at Yahoo or BartleBy)
Injection
1. Landmark guidance
  1. Direct needle at 60 to 90 degrees perpendicular to skin into joint
2. Ultrasound guidance (high frequency linear probe in longitudinal access)
  1. Direct needle out-of plane (transverse to Ultrasound probe) into joint

Efficacy

Ineffective in relieving pain in up to 50% of First Carpometacarpal Joint Osteoarthritis cases
High recurrence rates within 1-2 years after injection

References