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Injection of the first carpometacarpal joint

Injection of the first carpometacarpal joint

Hand function may be hampered by osteoarthritis in the first carpometacarpal joint. When a patient experiences pain that is not relieved by conservative therapies, a corticosteroid injection is indicated. Examination findings may include tenderness to compression and limited range of motion. Radiographic changes include joint-space narrowing and periarticular bony sclerosis. The joint space may be palpated at the palmar side of the tendons or within the snuffbox at its most distal end. If insertion of the needle is difficult, traction should be applied to the thumb. Careful positioning is vital to avoid injection of the more proximal portion of the anatomic snuffbox because it contains the radial artery and superficial radial nerve. (J Musculoskel Med. 2008;25:295-296)

The base of the thumb (first carpometacarpal [CMC] joint) is a common site of osteoarthritis (OA), which may adversely affect hand function. Proper CMC joint function is critical for the fine, dexterous hand movements that are required for activities of daily living because it allows for the "opposition" movement of the thumb.

A corticosteroid injection is indicated when a patient experiences pain at the CMC joint that is not relieved by conservative therapies. These may include analgesics and analgesic creams, NSAIDs, and temporary immobilization with a thumb splint.

Examination findings may include tenderness to compression of the CMC joint, limited range of motion, crepitation, a bony prominence resulting from osteophyte formation, and radial subluxation of the base of the first metacarpal. Radiographic changes of CMC joint OA include joint-space narrowing and periarticular bony sclerosis.

This article is the eighth in a 12-part series on the most frequently injected joints and bursae. Here we discuss injection of the first CMC joint.

Suggested supplies

3-mL syringe with 27-gauge ?⁄?- to 1-inch needle; 0.5 to 1 mL of 1% lidocaine for anesthetic.
3-mL syringe with 25-gauge 1-inch needle; 5 to 10 mg of prednisone equivalents (we prefer 5 to 10 mg of a nonfluorinated corticosteroid, such as methylprednisolone) admixed with 0.5 mL of 1% lidocaine.
Alcohol wipes, povidone-iodine, or chlorhexidine for sterilization.
Local anesthesic: ethyl chloride topical spray (optional).
Needle cap or ballpoint pen to mark the site of insertion.
Nonsterile or sterile gloves.
Gauze pads and bandage.

 

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