The Accuracy of Common Hand Injections With and Without Ultrasound: An Anatomical Study

To, Philip; McClary, Kaylan N.; Sinclair, Micah K.; Stout, Brittany; Foad, Mohab B.; Hiratzka, Shannon L.; Stern, Peter J.

doi:10.1177/1558944717692086

Cited by 26 publications

(23 citation statements)

References 17 publications

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“…There is controversy in the literature regarding the increased accuracy of ultrasound-guided injections (USIs) as compared to landmarkbased-guided injections. One study showed that use of US increased the accuracy of carpometacarpal (CMC) joint injection from 63 to 94%, but did not significantly improve injection accuracy of other hand joints [5]. This review will additionally outline the effects of compounds injected for each hand condition, such as corticosteroids, hyaluronic acid (HA), and botulinum neurotoxin.…”

Section: Introductionmentioning

confidence: 99%

Injection Techniques for Common Chronic Pain Conditions of the Hand: A Comprehensive Review

et al. 2020

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Introduction: This compilation presents a comprehensive review of the literature on common chronic pain conditions of the hand. It briefly presents these common conditions with their biological background, diagnosis, and common management options. It then presents and compares the latest literature available for injection techniques to treat these diagnoses and compares the available evidence. Methods: A comprehensive literature review was performed in MEDLINE, PubMed, and Cochrane databases from 1996 to 2019 using the terms ''hand pain''

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Section: Introductionmentioning

confidence: 99%

Injection Techniques for Common Chronic Pain Conditions of the Hand: A Comprehensive Review

et al. 2020

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“…In this sense, particularly debated was the accuracy of TBOA injections with and without imaging guidance, nowadays represented essentially by ultrasound. Indeed, the consensus statement on viscosupplementation ( Henrotin et al, 2015 ) suggested to inject the trapezio-metacarpal joint under fluoroscopy or ultrasonography guidance and a recent United States cadaveric study showed a 25% higher accuracy when thumb-base joint was injected with ultrasound guidance compared to no imaging control ( To et al, 2017 ). Conversely, other studies demonstrated success rates comparable with those obtained under ultrasound-control when the injections were performed by an experienced physician based on palpation of landmarks ( Helm et al, 2003 ; Mandl et al, 2006 ).…”

Section: Discussionmentioning

confidence: 99%

New Trends in Injection-Based Therapy for Thumb-Base Osteoarthritis: Where Are We and where Are We Going?

et al. 2021

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Thumb-base osteoarthritis (TBOA) is a common condition, mostly affecting post-menopausal women, often inducing a significant impact on quality of life and hand functionality. Despite its high prevalence and disability, the therapeutic options in TBOA are still limited and few have been investigated. Among the pharmacological strategies for TBOA management, it would be worthwhile to mention the injection-based therapy. Unfortunately, its efficacy is still the subject of debate. Indeed, the 2018 update of the European League Against Rheumatism (EULAR) recommendations for the management of hand osteoarthritis (OA) stated that intra-articular (IA) injections of glucocorticoids should not generally be used, but may be considered in patients with painful interphalangeal joints, without any specific mention to the TBOA localization and to other widely used injections agents, such as hyaluronic acid (HA) and platelet-rich plasma (PRP). Even American College of Rheumatology (ACR) experts conditionally recommended against IA HA injections in patients with TBOA, while they conditionally encouraged IA glucocorticoids. However, the recommendations from international scientific societies don’t often reflect the clinical practice of physicians who routinely take care of TBOA patients; indeed, corticosteroid injections are a mainstay of therapy in OA, especially for patients with pain refractory to oral treatments and HA is considered as a safe and effective treatment. The discrepancy with the literature data is due to the great heterogeneity of the clinical trials published in this field: indeed, the studies differ for methodology and protocol design, outcome measures, treatment (different formulations of HA, steroids, PRP, and schedules) and times of follow-up. For these reasons, the current review will provide deep insight into the injection-based therapy for TBOA, with particular attention to the different employed agents, the variety of the schedule treatments, the most common injection techniques, and the obtained results in terms of efficacy and safety. In depth, we will discuss the available literature on corticosteroids and HA injections for TBOA and the emerging role of PRP and other injection agents for this condition. We will consider in our analysis not only randomized controlled trials (RCTs) but also recent pilot or retrospective studies trying to step forward to identify satisfactory management strategies for TBOA.

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“…Fluoroscopy demonstrated a 42% inaccuracy rate. 5 To et al 18 reviewed the accuracy of ultrasound-guided injections of several hand sites and found that CMC joint accuracy was improved by 25% with ultrasound. Hunter et al 9 also demonstrated poor accuracy of thumb CMC joint injections (63.6%) using anatomic landmarks compared with fluoroscopy-guided injection.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Image-Guided Corticosteroid Injections on Thumb Carpometacarpal Arthritis

Gershkovich

Boyadjian

Mica

2019

Hand (New York, N,Y.)

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Background: Arthritis involving the thumb carpometacarpal (CMC) joint is common in the adult population. Initial treatment includes corticosteroid injections. Injections can be performed with image guidance to assist with placement; however, the clinical benefits are unclear. Methods: This retrospective study used Truven Health Marketscan Research Databases to identify patients from 2003 to 2014 with common International Classification of Diseases, Ninth Revision (ICD-9) codes for osteoarthritis of the CMC joint, Common Procedural Terminology (CPT) codes for image and non-image-guided injections, and codes for surgical interventions. Length of time from injection until subsequent injection(s) and/or surgery was extrapolated for identified patients. Analysis of variance and binomial logistic regression were used to compare continuous variables and calculate odds ratios, respectively. Results: We identified 62 333 patients (68% women, 32% men), average age 59.7, with common ICD-9 diagnostic codes for CMC arthritis with respective injection CPT codes. The average number of days between the first and second injection for patients treated with non-guided injection was 237.3 versus 266.7 for image-guided injections. Of the 62333 patients, 8107 went on to operative treatment. Among operative patients, the average number of days to surgery following non-guided injection was 317.7 versus 333.7 days in the image-guided group. The average cost of performing non-image-guided injections was $203 less than using ultrasound. Conclusions: Image-guided thumb CMC injections do not result in significant increases in time between injections and do not lead to a meaningful delay to surgery. Future research needs to clarify the value of image-guided CMC injections in an increasingly economically conscientious health care environment.

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The Accuracy of Common Hand Injections With and Without Ultrasound: An Anatomical Study

Abstract: Carpal tunnel, first DC, and RC injections had an accuracy of greater than 90%. Thumb CMC injections have a lower accuracy (63%) and one can improve accuracy with U/S. The accuracy of U/S-guided injections is dependent on the user and their experience.

Cited by 26 publications

References 17 publications

Injection Techniques for Common Chronic Pain Conditions of the Hand: A Comprehensive Review

Injection Techniques for Common Chronic Pain Conditions of the Hand: A Comprehensive Review

New Trends in Injection-Based Therapy for Thumb-Base Osteoarthritis: Where Are We and where Are We Going?

The Effect of Image-Guided Corticosteroid Injections on Thumb Carpometacarpal Arthritis

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