Abstract
Background
The current treatment options available for Trapezio-metacarpal arthritis are injection, splint and ultimately surgery. The injections are predominantly done by General practitioners and no data is available to specialist.
Aim
To investigate accuracy of injection and efficacy of injection in terms of short and long term pain relief.
Methods
We recruited 25 patients during March 2010 - January 2011. All of these patients had AP, Lat, and special Roberts radiographs. The technique involved palpating and surface marking Trapezio-metacarpal joint in the theatre. Under fluoroscopy, needle placement was performed while the operator was blinded from the screen. The location of needle was confirmed and then operator was allowed visualize the position of needle. Every movement of needle or the thumb to get the needle in joint was considered as an attempt. All had premixed Local anaesthetic and Depomedrone injection in to the joint. Accuracy was confirmed by operator and patient. We recorded patient demographics, number of attempts required for correct needle placement, pre and 10 minutes post-injection visual analogue scale (VAS) pain score, and Nelson Score (NS)before and six weeks after injection.
Results
Mean age was 60(range 46–90). M:F(23:2). Dominant hand was affected in 14 cases. CMC J OA ranged from grade 2–4. First attempt was successful in 6 cases. Mean attempts required for accurate injection was 3(range 0–4). Mean pain pre-injection VAS was 7(range 4–10), 10 minutes following injection 0.5(range 0–4) and at 6 weeks 5(range 3–10). Mean pre-operative NS was 29.6(range 14–65) and at 6 weeks 32.4(range 14–55). The difference was not statistically significant (paired t test, p=0.24).
Conclusion
Our results suggest that blind injection of thumb CMCJ may not be accurate as it requires assessment and appreciation of surface anatomy. Accuracy can be definitely improved by radiological guided injection.
Limitations
Small number and short follow up.
