AI Article Synopsis
- The study focuses on finding a standardized method for palpation-guided injections in the STT joint to manage wrist arthritis, due to the lack of existing literature on the topic.
- Six fresh-frozen cadaveric specimens were used to compare different approaches (dorsal, volar, and radial) for needle placement, assessing their risks to nearby anatomical structures with the help of fluoroscopy.
- The findings suggest that the dorsal approach is the safest and most accurate for injections without the need for imaging techniques, while the volar and radial approaches pose risks to specific arteries.
Article Abstract
Purpose: Scaphotrapezium-trapezoid (STT) joint arthritis is one of the most common forms of wrist arthritis. Conservative management often involves corticosteroid injection. Despite this, there is a scarcity of literature on palpation-guided injection techniques for the STT joint. We aimed to determine a standardized palpation-guided injection method that is easily reproducible and poses minimal risk to local anatomic structures.
Methods: Six fresh-frozen cadaveric upper extremity specimens were tested. Access to the STT joint was attempted with dorsal, volar, and radial approaches. Fluoroscopy was used to confirm accurate placement within the joint. Needle placement was documented in relation to the surrounding soft tissue and bony landmarks were measured with a ruler, and the angle of the needle entry was recorded using a goniometer. The cadavers were carefully dissected to identify the surrounding neurovascular structures at risk of injury.
Results: To access the STT joint with the dorsal approach, the needle was angled at 90º and inserted one-third of the distance from the prominence of the base of the second metacarpal to Lister tubercle. No neurovascular structures were found in the immediate vicinity of the needle. For the volar approach, the needle was angled at 65º and inserted at the distal wrist crease, 1 cm ulnar to the radial border of the wrist, in line with the second metacarpal. The volar branch of the radial artery was at risk with this approach. For the radial approach, the needle was angled at 60º and inserted immediately dorsal to the extensor pollicis brevis tendon, midway between the radial styloid and the prominence of the thumb metacarpal base. The dorsal branch of the radial artery was at risk with this approach.
Conclusions: In a clinical setting where fluoroscopy or ultrasound is not readily available, the dorsal approach may allow for safe and accurate placement of the injectate into the STT joint.
Type Of Study/level Of Evidence: Therapeutic IV.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8991861 | PMC |
| http://dx.doi.org/10.1016/j.jhsg.2021.05.003 | DOI Listing |
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