Dorsal web injection technique in the treatment of trigger finger and trigger thumb. Anatomical study.
Infiltración comisural dorsal en el tratamiento del pulgar y los dedos en resorte. Estudio anatómico.
Anatomy
Anatomía
Dedo en resorte
Flexor tendon
Infiltración
Injection
Pulgar en resorte
Tendón flexor
Trigger finger
Trigger thumb
Journal
Revista espanola de cirugia ortopedica y traumatologia (English ed.)
ISSN: 2173-576X
Titre abrégé: Rev Esp Cir Ortop Traumatol (Engl Ed)
Pays: Spain
ID NLM: 101778596
Informations de publication
Date de publication:
Historique:
received:
05
12
2019
revised:
04
02
2020
accepted:
07
02
2020
pubmed:
23
3
2020
medline:
17
8
2021
entrez:
23
3
2020
Statut:
ppublish
Résumé
Corticosteroid injection is an effective treatment for trigger digits but the pain during the injection is an ever-present side effect. Since the palmar skin has a high density of sensitive receptors, injecting through dorsal skin could be less painful. Our aim was to assess whether a dorsal technique through the dorsal web is safe for extra-sheath injection of trigger fingers and thumb. This is an anatomical study in sixteen cadaveric hands. An injection through the dorsal web was performed on each digit. After careful resection of the palmar skin, the distance between the needle and the main anatomical structures was measured. The risk of major injury was considered high when the mean distance from the needle to the neurovascular bundle was below 1mm. The mean distance from the needle to the neurovascular bundle was 1.77mm. Two neurovascular injuries in 112 injections were observed, one nerve and one artery. The safest digit was the thumb while the most dangerous was the index finger. At the ring finger, the technique was safer when it was carried out from the dorso-radial. A subcutaneous injection near the flexor tendon sheath can be carried out through the dorsal web with a low, but present, risk of neurovascular injury. It could be useful for injection in the treatment of trigger finger and trigger thumb but it should be assessed in a clinical study.
Sections du résumé
BACKGROUND AND OBJECTIVE
OBJECTIVE
Corticosteroid injection is an effective treatment for trigger digits but the pain during the injection is an ever-present side effect. Since the palmar skin has a high density of sensitive receptors, injecting through dorsal skin could be less painful. Our aim was to assess whether a dorsal technique through the dorsal web is safe for extra-sheath injection of trigger fingers and thumb.
MATERIAL AND METHOD
METHODS
This is an anatomical study in sixteen cadaveric hands. An injection through the dorsal web was performed on each digit. After careful resection of the palmar skin, the distance between the needle and the main anatomical structures was measured. The risk of major injury was considered high when the mean distance from the needle to the neurovascular bundle was below 1mm.
RESULTS
RESULTS
The mean distance from the needle to the neurovascular bundle was 1.77mm. Two neurovascular injuries in 112 injections were observed, one nerve and one artery. The safest digit was the thumb while the most dangerous was the index finger. At the ring finger, the technique was safer when it was carried out from the dorso-radial.
CONCLUSIONS
CONCLUSIONS
A subcutaneous injection near the flexor tendon sheath can be carried out through the dorsal web with a low, but present, risk of neurovascular injury. It could be useful for injection in the treatment of trigger finger and trigger thumb but it should be assessed in a clinical study.
Identifiants
pubmed: 32199767
pii: S1888-4415(20)30015-1
doi: 10.1016/j.recot.2020.02.002
pii:
doi:
Types de publication
Journal Article
Langues
eng
spa
Sous-ensembles de citation
IM
Pagination
355-360Informations de copyright
Copyright © 2020 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.