Periprocedural Care
Equipment
Equipment used for thumb injection includes the following:
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Syringe, 3 mL
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Needle, 1 in. (2.5 cm), for drawing up into the syringe
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Needle, 27 gauge, 0.5 in. (1.25 cm), for injection
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Sterile examination gloves
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Povidone-iodine skin preparation with sterile gauze
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Corticosteroid, 1-2 mL (eg, triamcinolone acetonide or methylprednisolone acetate; see the image below)
Next:
Patient Preparation
Anesthesia
Local anesthetic agents (eg, bupivacaine 0.5% or lidocaine 1%) may be used. The local anesthetic can be mixed with the corticosteroid.
Positioning
For proper positioning, identify the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons by having the patient extend the thumb (see the image below). Mark the gap between the tendons, distal to the radial styloid. Place the patient's hand vertically with the radial side up in a relaxed position.
First dorsal compartment of hand, including abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons.
Previous
Media Gallery
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First dorsal compartment of hand, including abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons.
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Thumb injection: equipment (corticosteroid, anesthetic).
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Corticosteroid injection into thumb for de Quervain tenosynovitis.
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Right trigger thumb injection. Video courtesy of James R Verheyden, MD.
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Separate right trigger thumb injection. Video courtesy of James R Verheyden, MD.
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