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Hand & Wrist ultrasound-guided injections
We perform diagnostic ultrasound and ultrasound guided steroid injections for a variety of hand/wrist problems. These include:
Wrist joint osteoarthritis
There are multiple small bones and joints within the hand and the wrist. The main wrist joint is formed by the articulation between the two forearm bones (the radius and the ulna) and the bone of the hands (the carpal bones). Osteoarthritis refers to the wear and tear changes that can affect the wrist joint. There will be thinning or loss of the cartilage causing bone exposure. This can be very painful and limiting to movement. The main symptoms will be pain and limitation of wrist movement. The pain is usually worse after activity or at the end of the day. If the arthritis progress, the pain can be triggered by simple daily activities (like using a door handle) and can be very limiting. Nodules can form in the wrist or fingers due to focal areas of bony overgrowth. To find out more, Please read our article about wrist arthritis.
Thumb base (CMC) joint arthritis
This is one of the most common hand conditions in our practice. It refers to osteoarthritis (wear and tear changes) that involves the thumb carpometacarpal (CMC) joint. This joint is located at the thumb's base between the metacarpal and another small bone called “trapezium”. Symptoms usually include pain, swelling and stiffness at the base of the thumb. The pain is increased by activities that involve gripping. Small bony lumps can be felt under the skin at the thumb base due to bone overgrowth at the site of arthritis. To find out more, please see our article about Thumb base arthritis. Ultrasound guided steroid injection to the thumb CMC joint can help reduce the pain. This is one of the most common indications for ultrasound guided steroid injection in the hand we see in our practice. Ultrasound guidance allows for the delivery of the medicine directly and accurately into the joint.
De Quervain's tenosynovitis
Dequervain’s tenosynovitis is caused by inflammation of a certain tendon group that runs outside the wrist (the 1st extensor compartment tendons). The inflammation usually involves the tendons and the tendon sheath (the coverings of the tendons). The tendons need to glide smoothly through the sheath during movement, but in this condition, the thickening and inflammation of the tendon sheath will prevent this. This will result in pain and restriction of wrist and thumb movements. The condition is common in those who perform repetitive movements of the thumb and the wrist and also new parents (particularly mums) due to repeated carrying of the new borne. If conservative treatment with physiotherapy, thumb splint and anti-inflammatory tablets is ineffective, then an ultrasound guided steroid injection to the tendon sheath can help reduce the pain and inflammation. Ultrasound guidance is crucial to establish the diagnosis when performing steroid injections to increase accuracy and reduce side effects. Please see our article to learn more about De Quervain's tenosynovitis.
This is an overuse condition that can affect the fingers. Normally, the finger tendons glide smoothly inside their coverings (called the tendon sheath) during movement, and they are held in position by special structures (called the pulleys). In a Trigger finger, there is usually thickening of the pulley preventing smooth gliding of the tendon within its sheath. It then can result in thickening of the tendon sheath, referred to as “stenosing tenosynovitis”. The condition is characterised by pain and restriction of the finger movements associated with clicking or triggering. To find out more, please see our article Trigger finger.
Ultrasound is very useful for performing a dynamic assessment of the tendons and establishing the diagnosis. If conservative management is not helping, then ultrasound guided steroid injection can be considered. The steroid medication is injected under ultrasound guidance into the tendon sheath and immediately deep into the thickened pulley. This would help to reduce inflammation and improve the patient's symptoms.
Carpal tunnel syndrome
Carpal tunnel syndrome is caused by pressure upon the median nerve as it passes through a specific anatomical tunnel through the wrist joint, called the carpal tunnel. The top of the tunnel is formed by a band of thick tissue called "the flexor retinaculum". Any factor that can cause increased pressure within the carpal tunnel, can result in pressure upon the median nerve. To find out more, please see our article about Carpal tunnel. Initial management of carpal tunnel syndrome includes treatment of the underlying cause, physiotherapy and using a wrist splint. Failing this, an ultrasound guided carpal tunnel steroid injection can be considered. It can provide good pain relief in up to 80% of the cases and ensure safe and accurate delivery of the medicine into the carpal tunnel around the median nerve, to avoid injury to the nerve and other important structures within the carpal tunnel. To learn more about the role of ultrasound in assessing the carpal tunnel, please see our article.
Ganglion cyst and ultrasound-guided aspiration/steroid injection
Ganglion cysts are thin-walled fluid-filled sacs most commonly seen around the wrist joint but they can occur in any part of the body. They are usually seen close to joints or tendons as they usually arise from the joint or the tendon sheath (the covering of the tendon). The exact cause is not certain but they are thought related to degenerative changes to the joint or tendon resulting in an increase in fluid production which can result in these ganglion cysts. The fluid is usually thick and jelly-like.
A ganglion cyst usually results in a lump at the wrist or the foot. The lump can be hard and can change in size or disappear. If the ganglion cyst is large enough, it can cause pressure upon any adjacent structures. It can result in pain or numbness if it is causing pressure upon a nerve within the wrist. Aspiration of the cyst under ultrasound guidance is an option. Injecting a small dose of steroid after the aspiration aims to reduce the inflammation in the area and reduce the chance of ganglion cyst recurrence, but this remains a possibility. Using ultrasound guidance will ensure accurate needle placement and avoid injuring important structures adjacent to the ganglion cyst. To learn more, please see our article about Ganglion cyst and ultrasound-guided ganglion cyst aspiration.
Frequently asked questions about hand & wrist pain and injections
When shall I consider a thumb cortisone injection?
Generally, managing most hand and wrist conditions starts with physiotherapy treatment and progressive rehabilitation. The duration of this depends on the condition. If the response from the above is slow or not satisfactory, then an ultrasound-guided cortisone injection may be considered. Injection therapy can be very useful in reducing pain and improving function, allowing for more effective rehabilitation. We always advise performing thumb and wrist injections under ultrasound guidance by an experienced doctor to ensure accurate medicine delivery to the targeted area.
What is a thumb cortisone injection?
Corticosteroid (cortisone) is a potent anti-inflammatory medicine routinely used to manage inflammatory conditions (like bursitis, arthritis and tendinosis). A cortisone injection will reduce the inflammation in the injected area (like the thumb base or the carpal tunnel) and allow you to manage the condition, usually by undergoing a physiotherapy program. To learn more, please read our article on steroid injection for thumb arthritis.
Should hand & wrist injections be done under ultrasound guidance?
Yes. This is our routine practice, as plenty of evidence supports ultrasound guidance when performing joint injections. Doing wrist injections under ultrasound/imaging guidance allows for direct visualisation of the needle to ensure accurate placement into the area of pain/inflammation (like a bursa, an arthritic joint or an inflamed tendon sheath). Ultrasound guidance results in more accurate, less painful and faster procedures, with better outcomes than these injections without guidance. Ultrasound guidance avoids sensitive structures (like nerves and vessels) during the procedure.
Are thumb cortisone injections safe?
Yes, generally these injections are very safe and routinely done in our practice. There is a very small risk of infection (about 1:10.000). The procedure will be explained to you in detail during your appointment and all your questions will be addressed. To find out more about cortisone injection in general, please see our FAQs.
What are the commonly used steroid medicines in wrist injections?
Triamcinolone (Kenalog) and methylprednisolone (Depo-medrone) are commonly used steroid injections for musculoskeletal conditions. These preparations are long-acting steroid injections that normally take a few days to start working.
How long will the effect of a wrist/finger cortisone injection last?
A steroid injection usually takes a few days (1-3) before you notice the effect, although sometimes the pain relief can start on the same day. More commonly, the injected area will feel sore for the first few days. This is referred to as (steroid flare) and can be seen after a steroid injection.
What is the benefit of imaging in patients with hand and wrist pain?
Imaging plays a vital role in establishing the correct diagnosis, assessing the condition's severity and deciding the best treatment options. To get the correct diagnosis, you must be assessed by an experienced practitioner (a hip specialist doctor or an experienced physiotherapist). In most cases, imaging will be needed to confirm the diagnosis and assess the severity of the condition. Ultrasound is very useful to assess the tendons and nerves around the wrist joint and perform a dynamic assessment. To find out more, please see our article about wrist ultrasound assessment. Ultrasound is also extremely useful to guide injection therapy.
How soon will a steroid injection start to work?
Current evidence suggests that cortisone can improve pain and function for up to 3 months, but in some cases, it can last longer. The duration of pain relief depends on the diagnosis and severity of condition. The steroid injection will provide a window of opportunity to undergo effective rehabilitation and attempt to address the underlying cause, to enhance the pain relief achieved from the injection.
Do steroid injections just hide/mask the pain?
Steroid injections do not just mask or hide the pain but they act by reducing the inflammation in the targeted area, thus providing a strong and local anti-inflammatory effect to help control the symptoms and allow the patient to manage the condition, usually by undergoing effective rehabilitation.
How many steroid injections can I have?
We advise reducing the number of cortisone injections if possible, by combining any injection therapy with an effective physiotherapy programme to address the underlying cause. Repeated steroid injection into the same area should be avoided if the previous injection was less than 3-4 months ago.
Are thumb arthritis injections painful?
Pain is very subjective and people have different pain thresholds. The majority of patients experience some discomfort during the injection but the corticosteroid is usually mixed with a local anaesthetic (numbing medicine) to enhance the pain relief. This will provide immediate pain relief that usually lasts for a few hours. We use ultrasound guidance to ensure the procedure is quick and efficient. Ultrasound ensures needle visualisation to choose the safest path for the injection and avoid any important or sensitive structures.
How long should I rest after a thumb injection?
Usually, we advise patients to rest for 48-72 hours after having the injection.
Hand & Wrist conditions and treatments
The Musculoskeletal Ultrasound & Injections clinic
169 Richmond Road
Kingston upon Thames
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