From the Guidelines
The trigger point injection technique for the proximal joint of the ring finger involves injecting a local anesthetic into tender nodules or bands in the muscles surrounding the proximal interphalangeal (PIP) joint, with careful consideration of aseptic technique and patient monitoring, as recommended by recent guidelines 1.
Key Considerations
- The technique involves palpating the area to identify the specific trigger point, which typically feels like a taut band or nodule that reproduces the patient's pain when pressed.
- After cleaning the area with alcohol or betadine, a 25-27 gauge needle is used to inject 0.5-1 ml of anesthetic solution directly into the trigger point.
- The needle should be inserted perpendicular to the skin and advanced into the trigger point, with aspiration performed before injection to avoid intravascular administration.
- Multiple passes through the trigger point in a fan-like pattern may help disrupt the taut bands.
- Patients should be monitored for 15-30 minutes post-procedure for any adverse reactions, and gentle pressure and active range of motion exercises can be applied after injection.
Important Guidelines
- Aseptic technique should always be undertaken when performing injections, including the use of surgical gloves, skin preparation with alcohol, iodine disinfectant or chlorhexidine, and changing needles between drawing the drug and injecting it into the joint 1.
- Patients should be offered local anaesthetic and informed about the pros and cons, as well as the potential risks and benefits of the procedure 1.
- The decision to reinject a joint should take into consideration benefits from previous injections and other individualised factors, such as treatment options, compound used, systemic treatment, and comorbidities 1.
Relevant Studies
- A recent study showed that the current risk of septic arthritis following intra-articular injections could be higher than previously thought, highlighting the importance of careful technique and patient monitoring 1.
- Another study demonstrated the efficacy of intra-articular injections of glucocorticoids in patients with hand OA, but noted that this treatment should not generally be used in patients with hand OA, except in specific cases such as painful interphalangeal joints 1.
From the Research
Trigger Point Injection Technique
The trigger point injection technique for the proximal joint of the ring finger involves injecting a substance, such as a local anesthetic, corticosteroid, or botulinum toxin, into the affected trigger point to relieve pain and discomfort [ 2 ].
Administration of Injectate
The administration of injectate can be performed with or without imaging guidance, such as fluoroscopy and ultrasound [ 2 ]. The use of imaging guidance has been recommended to improve patient outcome and safety.
Types of Injectate
The types of injectate used for trigger point injections include:
- Local anesthetics
- Corticosteroids
- Botulinum toxin
- No injectate (dry needling) [ 2 ]
Efficacy of Trigger Point Injections
Some evidence from clinical trials supports the use of trigger point injections for myofascial pain syndromes [ 3 ]. However, conclusions are limited by low numbers of study participants, difficulty in blinding, the potential for a placebo effect, and lack of posttreatment follow-up.
Treatment of Trigger Finger
Trigger finger can be treated with immobilization, steroid injections, and open surgical release of the A1 pulley [ 4 ]. The efficacy of steroid injections for trigger finger varies based on the number of affected digits and the clinical severity of the condition.
Key Points
- Trigger point injections can be performed with or without imaging guidance
- The administration of injectate can include local anesthetics, corticosteroids, botulinum toxin, or no injectate (dry needling)
- Trigger point injections should be reserved for patients whose myofascial pain has been refractory to other measures [ 3 ]
- The use of corticosteroids in trigger point injections has minimal benefit [ 5 ]