De Quervain Injection

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De Quervain Injection
Indication	De Quervain Tendinopathy
Syringe	1mL
Needle	25G 16mm
Steroid	10-20mg triamcinolone
Local	0.75mL 2% lidocaine
Volume	1mL

Background

Injection for De Quervain Tendinopathy.

Anatomy

The APL and EPB usually run together in the first dorsal compartment. The tendons can often be seen with the thumb held in resisted extension. They can also be palpated at the base of the 1st metacarpal.

Technique

• Injection site
  • Usual site is between 5-10mm proximal to the tip of the radial styloid, between the two tendons, through the retinaculum, within the sheath.
  • Alternative site in very thin patients, inject distal to the retinaculum.
• Position: Ulnar side of hand resting on surface with thumbheld in slight flexion
• Identify the gap between the two tendons
• Insert needle perpendicularly into the gap then slide proximally between the tendons (needle going distal to proximal)
• Inject solution as a bolus

Complications

• Subcutaneous fat atrophy, particularly noticeable in dark skinned thin women. This may be permanent but generally resolves within 3 months. The risk can be reduced by using hydrocortisone.
• Trauma to superficial radial nerve

Aftercare

Rest hand for one week with taping. Avoid provoking activities and start a graded load programme.