Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Nov;12(6):591-596.
doi: 10.1177/1558944717692086. Epub 2017 Feb 1.

The Accuracy of Common Hand Injections With and Without Ultrasound: An Anatomical Study

Philip To  1 , Kaylan N McClary  2 , Micah K Sinclair  2 , Brittany A Stout  3 , Mohab Foad  3 , Shannon Hiratzka  4 , Peter J Stern  2
Affiliations

The Accuracy of Common Hand Injections With and Without Ultrasound: An Anatomical Study

Philip To et al. Hand (N Y). 2017 Nov.

Abstract

Background: The aim of the study is to determine the accuracy of hand injections with and without the aid of ultrasound (U/S) into the carpal tunnel, thumb carpometacarpal (CMC) joint, first dorsal compartment (DC) and the radiocarpal (RC) joint.

Methods: Four participants of various level of experience injected the carpal tunnel, thumb CMC, first DC, and RC joint into 40 fresh frozen cadaver specimens with blue dye and radiographic contrast. Participants 1 and 2 were injected without U/S guidance, and participants 3 and 4 were injected with U/S guidance. A successful injection was determined by both fluoroscopy and dissection/direct observation. Additional information was recorded for each injection such as median nerve infiltration and evidence of thumb CMC arthrosis.

Results: The overall accuracy for carpal tunnel, thumb CMC, first DC, and RC injections were 95%, 63%, 90%, and 90%, respectively. Success was compared with and without U/S guidance. Success rates were similar for each injection site, except the thumb CMC joint, where U/S participants had 25% higher accuracy. In the setting of thumb CMC arthrosis, the incidence of success was 38% for participants with no U/S aid and 72% for participants with U/S aid. There was a significant difference between participants who used U/S with the participant with more U/S experience being more successful.

Conclusion: Carpal tunnel, first DC, and RC injections had an accuracy of greater than 90%. Thumb CMC injections have a lower accuracy (63%) and one can improve accuracy with U/S. The accuracy of U/S-guided injections is dependent on the user and their experience.

Keywords: De Quervain; carpal tunnel; radiocarpal; thumb carpometacarpal.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Anteroposterior (a) and lateral (b) views of a successful carpal tunnel injection.
Figure 2.
Figure 2.
Radiograph demonstrating a successful thumb carpometacarpal injection.
Figure 3.
Figure 3.
Photograph of a successful first dorsal compartment injection on anatomic dissection.
Figure 4.
Figure 4.
Photograph of a successful radiocarpal injection on anatomic dissection.
Figure 5.
Figure 5.
Anteroposterior wrist demonstrating a missed thumb carpometacarpal injection superficial to the scaphotrapezialtrapezoid joint.
Figure 6.
Figure 6.
Ultrasound images of the first dorsal compartment with and without an EPB subsheath (as indicated by the arrow mark). Note. EPB = extensor pollicis brevis.
See this image and copyright information in PMC

References

    1. Anderanin L. Coding tips for the orthopaedic office. Healthcare Information Services. http://www.slideshare.net/ReimbursementMD/coding-tips-for-busy-orthopaed.... Published 2012. Accessed September 29, 2014.
    1. Cunnington J, Marshall N, Hide G, et al. A randomized, double-blind, controlled study of ultrasound-guided corticosteroid injection into the joint of patients with inflammatory arthritis. Arthritis Rheum. 2010;62(7):1862-1869. - PubMed
    1. Di Sante L, Cacchio A, Scettri P, et al. Ultrasound-guided procedure for the treatment of trapeziometacarpal osteoarthritis. Clin Rheumatol. 2011;30(9):1195-1200. - PubMed
    1. Hajder E, de Jonge M, van der Horst C, et al. The role of ultrasound-guided triamcinolone injection in the treatment of De Quervain’s disease: treatment and a diagnostic tool? Chir Main. 2013;32(6):403-407. - PubMed
    1. Helm A, Higgins G, Rajkumar P, et al. Accuracy of intra-articular injections for osteoarthritis of the trapeziometacarpal joint. Int J Clin Pract. 2003;57(4):265-266. - PubMed

Publication types

LinkOut - more resources