The top 5 wrist and hand injections
There are some conditions where wrist and hand injections really do provide the best solution – here are the top 5 injections.
Of course the anatomy is intricate (I love teaching this – it is so interesting!) and, when it comes to wrist and hand injections, accuracy is crucial – but the results can be amazing. Here are the top 5 conditions where injections can provide the best solution.
1. de Quervain’s tenosynovitis
de Quervain’s tenosynovitis is the name given to an overuse injury affecting 2 of the thumb tendons. Inflammation develops between the tendons and the surrounding sheath and this causes intense pain during thumb movement.
It is common among young women with small babies who have to do a lot of picking up and holding but can affect anyone.
Initially patients are told to rest and wear a splint to allow recovery but this can take quite a long time leaving them carrying a very painful condition. A cortisone injection will bring considerable relief within 2-3 days and is often curative, particularly if the problem has not been allowed to drag on too long – quite possibly a miracle cure…
2. Thumb arthritis
A common wrist and hand injection is the joint at the base of the thumb (basal joint) as this is the most common site of osteoarthritis in the wrist and hand. Arthritis of the basal joint is characterised by pain, stiffness, loss of grip power and swelling. If the condition becomes advanced the thumb can start to drift in towards the palm of the pain making day to day activities even more painful. Conservative treatment includes splinting and anti-inflammatory medication or cream but this often fails to bring adequate reduction in pain and disability. Injection of cortisone or hyaluronic acid both provide excellent treatment options for this condition in combination with physiotherapy treatment.
3. Trigger finger/thumb
This condition can affect the tendons of the finger (trigger finger) or thumb (trigger thumb) and the patient will experience the finger ‘catching’ when it straightens from a flexed position. If it worsens, the finger can lock in a bent position causing pain and distress for the patient.
The medical term for the condition is stenosing tenosynovitis. It is caused by local swelling or thickening of the tendon that then is unable to travel smoothly during bending and straightening movements forcing it to ‘catch’ or ‘lock’. A cortisone injection helps to reduce the inflammation which in turn allows the tendon to move freely.
4. Carpal Tunnel Syndrome
The carpal tunnel at the wrist is a space through which tendons pass along with the median nerve which supplies sensation to the thumb, index, 3rd and half of the 4th finger. Carpal tunnel syndrome is caused by compression of the median nerve as it passes through the tunnel causing tingling in the fingers the nerve supplies initially but this can become painful too. It is common in pregnancy and also in patients with diabetes, hypothyroidism or obesity. Patients will often report numbness in the same area too. Symptoms typically start gradually and are most noticeable during the night. The condition can affect grip strength which over time can lead to wasting of the thenar eminence (the small muscles at the base of the thumb). Depending on what is causing the symptoms, a cortisone injection can quickly alleviate the symptoms and very often is resolves the problem permanently.
5. Wrist and hand injections for arthritis
The wrist joint is not commonly involved but can be affected by arthritis, particularly after a wrist fracture. The symptoms may take years to develop but pain and stiffness, particularly when weight-bearing (e.g. when on all 4’s) are the tell tale signs of arthritis. Sometimes the joint becomes swollen and this can be felt over the joint line. Injection treatment will bring a significant improvement in pain and allow recovery of movement and day to day function with cortisone and hyaluronic acid being options here.