Procedure

Tendon Sheath Injection

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Tendon Sheath Injection

  • See Also
  1. Corticosteroid Injection
  2. Joint Injection
  3. Soft Tissue Injection
  4. Trigger Point Injection
  5. LAST Reaction
  • Indications
  1. Tendinitis adjunctive therapy
    1. May reduce pain and improve function in the short term
    2. Should be accompanied by other Tendinitis specific management (e.g. physical therapy)
  2. Regions
    1. Shoulder
      1. Biceps Tendon Injection
    2. Elbow Epicondyle Injection
      1. Lateral Epicondyle Injection
      2. Medial Epicondyle Injection
    3. Hand
      1. De Quervain's Tenosynovitis Injection (Abductor Pollicis Longus Sheath Injection)
      2. Trigger Finger Corticosteroid Injection (Digital Flexor Tenosynovitis Injection)
    4. Hip
      1. Trochanteric Bursa Injection
    5. Knee
      1. Iliotibial Band Injection
      2. Pes Anserine Injection
      3. Prepatellar Bursa Injection
  • Contraindications
  1. Significant Tendon Injury or partial rupture
  2. Recent or multiple injections at the same site
    1. Avoid repeat injection within 3-4 months
  3. Infection (overlying Cellulitis, bacteremia)
  4. Uncontrolled Diabetes Mellitus
  5. Coagulopathy
  • Adverse Effects
  1. Specific adverse effects
    1. Tendon rupture or atrophy
    2. Fistula formation from the tendon sheath
      1. Z-Tracking needle (redirecting needle when within subcutaneous fat) reduces fistula risk
  2. General injection related adverse effects
    1. Local infection
    2. Bleeding
    3. Systemic effects of Corticosteroids (e.g. Hyperglycemia)
    4. LAST Reaction (e.g. intravascular injection of Anesthetic)
  • Technique
  1. See regional indications above for specific tendon approaches
  2. Informed Consent
  3. Identify landmarks (anatomy, Ultrasound) and mark injection site
  4. Prepare injection site (e.g. Chlorhexidine, Povidone Iodine)
  5. Insert needle (consider z-tracking), advancing slowing and stopping if Paresthesia
  6. Aspirate for intravascular location
  7. Inject slowly at insertion site
  • References
  1. Warrington (2023) Crit Dec Emerg Med 37(1): 14-5