Wrist Joint Injection

Acute capsulitis

Causes and findings:
• Rheumatoid arthritis
• Trauma
• Pain in and around wrist joint. There may also be heat, palpable synovial thickening and/or swelling
• Painful limitation in the capsular pattern - equal, loss of passive extension and flexion with hard end-feel

Equipment:
Syringe - 2ml
Needle - 23G 1.25 inches (30mm) blue
Kenalog 40 - 20 mg
Lidocaine - 1.5 ml 2%
Total volume - 2 ml

Anatomy:
The wrist joint capsule is not continuous and has septa dividing it into separate compartments. For this reason it cannot be injected at one spot, but requires several areas of infiltration through one injection entry point.

Technique:
• Patient places the hand palm down in some degree of wrist flexion
• Identify mid-carpus proximal to hollow dip of capitate
• Insert needle at mid-point of carpus
• Inject at different points across the dorsum of the wrist, both into the ligaments and also intracapsular where possible

Aftercare:
The patient rests in a splint until the pain subsides and then begins gentle mobilizing exercises within the pain-free range. Wax baths can be most beneficial
because the wax can be used as an exercise medium after being peeled off the hands.

Comments:
This is a common area for injection in patients with rheumatoid arthritis. Patients with other causes such as trauma, overuse or osteoarthritis usually respond well to a short period of pain-relieving modalities, medication and rest in a splint, followed by passive and active mobilization techniques. As in all cases of trauma, fracture, especially of the scaphoid, should be eliminated.

Alternative approaches:
If the joint is badly affected and swollen, it might be necessary to use a longer needle to reach all around the area, or to inject at several points.