From the FDA Drug Label
Recommended Doses for Intra-articular Injection Size of Joint Location Dose (mL) ... Small (metacarpophalangeal, interphalangeal) (sternoclavicular) Hand, chest 0.25 to 0.5
The steroid to use for hand injections is Betamethasone Sodium Phosphate and Betamethasone Acetate Injectable Suspension, with a recommended dose of 0.25 to 0.5 mL for small joints in the hand, such as metacarpophalangeal or interphalangeal joints 1.
From the Research
For hand injections, triamcinolone acetonide (Kenalog) at a dose of 20 mg is the preferred steroid, as it has been shown to have a significantly higher rate of clinical effectiveness at 6-month follow-up compared to lower doses 2.
Key Considerations
- The specific dose depends on the condition being treated and the size of the joint or area, but generally ranges from 5-20 mg for smaller hand joints.
- Triamcinolone acetonide is favored because it provides a good balance between potency and duration of action, typically lasting 2-3 weeks in the system.
- When performing hand injections, it's often mixed with a local anesthetic like lidocaine 1% (0.5-1 mL) to provide immediate pain relief while waiting for the steroid to take effect.
Important Details
- The injection should be performed using aseptic technique with a 25-27 gauge needle.
- Common indications include trigger finger, De Quervain's tenosynovitis, carpal tunnel syndrome, and osteoarthritis of the hand joints.
- Patients should be advised to rest the injected area for 24-48 hours after the procedure and monitor for potential side effects such as skin discoloration, tendon weakening, or infection.
- Multiple injections should be limited to 3-4 per year in the same location to minimize tissue damage and systemic absorption.
Supporting Evidence
- A study published in 2024 found that a 20-mg dose of triamcinolone acetonide had a significantly higher rate of clinical effectiveness at 6-month follow-up compared to 5-mg and 10-mg doses 2.
- Another study published in 2018 also found a dose-related pattern in the treatment of trigger finger with triamcinolone acetonide, with the 20-mg group having a significant higher success rate at 3 and 6 months 3.