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Subject: Trigger Finger Injection
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Syringes (1 or 3 mL), needles (25 or 27 gauge, 5/8 inch), and alcohol swabs are available from local surgical supply houses or pharmacies.
Steroid solutions are available from manufacturers or local pharmacies. Celestone Soluspan (beta-methasone sodium) is produced by Schering-Plough (Kenilworth, NJ, www.schering-plough.com); Aristocort (triamcinolone diacetate) and Aristospan (triamcinolone hexacetonide) can be obtained from Baxter-Lederle (Deerfield, IL, www.baxter.com); and Depo-Medrol (methylprednisolone acetate) is available from Pharmacia Upjohn (Basking Ridge, NJ, www.pharmacia.com).
A suggested tray for performing soft-tissue aspirations and injections is listed in Appendix I.
Skin preparation recommendations appear in Appendix E.
Locking of flexor tendon of finger or thumb (i.e., flexor tendon entrapment syndrome)
Failure to respond to multiple injections
Bacteremia or cellulitis of the palm or thumb
Congenital trigger thumb in infants
PITFALL: Novice physicians frequently inject at the base of the digit (i.e., crease where the digit meets the palm). This is well above the metacarpophalangeal joint and above the A1 pulley. The joint can be palpated through the palm; it is at least 1 cm proximal to the crease at the base of the finger.
Pearl: The needle may enter the nodule with a distinct grating sensation. This may be verified by asking the patient to gently move the digit, and observing the needle move with the digit. The needle should be withdrawn very carefully until a give-way sensation is felt, indicating that the tip of the needle is in the sheath before injection.
PITFALL: Topical ethyl chloride may be used preinjection if the patient is especially fearful of the needle stick.
Short-term increased tenderness
Numbness in the digit due to local anesthetic coming into contact with a digital nerve
Tendon rupture (rare)