Trigger Finger Injections

Question 1

What are the most ideal needles to use?

Answer 1

25-30 gauge, 1.5 inch needle

Question 2

What is the most appropriate transducer?

Answer 2

High frequency, linear array

Question 3

What should be avoided during injection?

Answer 3

Interdigital arteries and nerves

Question 4

Where does the first annular (A1) pulley arise?

Answer 4

volar plate of the MCP joint

Question 5

What can be used as a surface marker for the A1 pulley?

Answer 5

Proximal finger crease

Question 6

Which tendon splits at the level of the A1 pulley?

Answer 6

FDS splits & FDP becomes more superficial

Question 7

What are predisposing factors for tenosynovitis?

Answer 7

DM
RA
Gout
Trauma

Question 8

What are sx for tenosynovitis?

Answer 8

Pain, catching or locking in finger w/flexion and extension

Snapping at proximal phalangeal joint

Question 9

How will tenosynovitis be visualized on US?

Answer 9

Hypoechoic layer around the flexor tendons & enlargement of tendons distal to A1 pulley

Question 10

What are indications for injection?

Answer 10

Alleviate pain, locking, catching

Question 11

What are contraindications for injection

Answer 11

Uncontrolled DM
Inmmunosuppression
Active systemic or local infection
Compromised skin over region
H/o adverse reaction to steroid or anesthetic

Question 12

What is the transducer position for injection?

Answer 12

Long axis to flexor tendons and A1 pulley at level of MCP joint

Question 13

How much steroid and local anesthetic should be used?

Answer 13

0.5 ml steroid and 0.5 ml local anesthetic