Trigger finger and carpal tunnel

After marking the intersection of the palmaris longus and distal palmar crease, next go xxx to that site; this will be the point of injection

1 cm proximal and 1 cm ulnar

When doing a carpal tunnel syndrome injection, use a xxx with desired steroid and 1 mL of 1% xxx

25 gauge needle; lidocaine

When doing a carpal tunnel syndrome injection, put the needle at a xxx angle to the skin and direct the needle towards the base of the thumb and advance the needle distally and slowly

45 degree

When doing a trigger finger injection, first palpate the entire tendon and locate the nodule swelling at the xxx (near or over the MCP joint)

A1 pulley

•Ice •NSAIDS/acetaminophen •Topical gels/patches •Rest •Wrist splints •Avoid submersion in water, 48 hours •Activity modification

Aftercare for carpal tunnel syndrome injection

•Inform patient of risks and benefits •Obtain written consent •Verify with patient using 2 identifiers name, procedure and location to be completed •Obtain supplies •Wash hands •Mark appropriate site •Prepare skin •Apply gloves

Before injection process

•Post-injection flare, 2-10% •Infection, <0.001-0.072% •Tendon rupture, <1% •Vasovagal reaction, 10-20% •Facial flushing, <1% •Hypersensitivity, <1% •Bruising •Nerve damage •Thinning of skin, bone, pigment at injection site •Elevated blood pressures, sugars

Complications for carpal tunnel syndrome injection

The median nerve supplies sensation to which digits? A Digits 1-5 B Digits 1-4 C Digits 1-3 D Digit 1

Digits 1-4

When doing a carpal tunnel syndrome injection, first locate the palmaris longus and the flexor carpi radialis tendon (the median nerve is located between these two structures). Then locate the...

Distal palmar crease

Which is NOT a recommended aftercare instructions for a trigger finger injection? A Avoid submersion in water for 48 hours B Bracing C Avoid pinching and grasping D Ice E Heat

Heat

•Carpal tunnel syndrome (CTS) - compression of the median nerve as it travels through the carpal tunnel (severe or failed conservative treatment) •Pain, paresthesia, weakness in the median nerve distribution

Indications for carpal tunnel syndrome injection

•Activity modification •Early intervention (ice, NSAIDS, activity modification, splinting)

Prevention of trigger finger injection

•Flexor tendon catches when it attempts to glide through a stenotic sheath •Painless snapping, catching or locking; progresses to pain •Inability to smoothly flex or extend the finger •Locked in flexion or extension, requires passive manipulation to achieve normal motion •One of the most common causes of hand pain •Can occur in one or more fingers and can be bilateral •Prevalence is higher in patients with diabetes, rheumatoid arthritis, or conditions that cause systemic deposition of protein such as amyloidosis

Trigger finger

Caused by a disparity in the size of the flexor tendons and the surrounding retinacular pulley system at the first annular (A1) pulley which overlies the metacarpophalangeal (MCP) joint

Trigger finger (stenosing flexor tenosynovitis)

•Ice •NSAIDS/acetaminophen •Topical gels/patches •Rest •Avoid submersion in water, 48 hours •Splinting/bracing/taping •Activity modification (pinching/grasping) Prevention: •Activity modification •Early intervention (ice, NSAIDS, activity modification, splinting)

aftercare of trigger finger injection

•Hypersensitivity to injection agents •Bloody effusion •Infection, suspected infection, broken skin •Trauma/fracture •Upcoming oral/urinary manipulations •Injection <3 months prior •Joint surgery ≤ 3 months •Prior injections not effective* •Prior steroid injection flare* •Prosthetic joint •Immunocompromised •Unstable coagulopathy, platelet dysfunction syndrome, critical thrombocytopenia •INR >3 •Anemia* •Cancer* •Diabetes**

contraindications of trigger finger and carpal tunnel syndrome injections

Injection of soft tissues or peritendinous injections can cause xxx in blood glucose that persist from five to 21 days.

elevations

When doing a trigger finger injection, use which topical anesthetic prior to injection?

ethyl chloride

Single intra-articular steroid injections have xxx on glycemic control.

little or no effect

After locating the distal palmar crease, mark the intersection of the xxx and the distal palmar crease

palmaris longus

When doing a carpal tunnel syndrome injection, first locate the xxx tendons (the median nerve is located between these two structures)

palmaris longus and the flexor carpi radialis

Trigger finger injection is indicated for...

trigger finger that is severe or failed conservative therapy

How do you mark the injection site for a trigger finger injection?

•An otoscope tip works well to mark the injection site so that the skin can be prepped and the mark remains •A sterile marking pen is another option