Who performs hand injections?

Who Performs Hand Injections

Hand injections are typically performed by rheumatologists, orthopaedic surgeons, plastic surgeons, sports medicine specialists, physical medicine and rehabilitation physicians, and occasionally trained primary care physicians. 1 The choice of specialist may depend on the specific condition being treated and local healthcare system organization.

Types of Specialists Performing Hand Injections

• Rheumatologists: Experts in managing inflammatory and autoimmune conditions affecting joints, with extensive training in joint injections
• Orthopaedic surgeons: Particularly those specializing in hand surgery
• Plastic surgeons: Especially those with hand surgery specialization
• Sports medicine specialists: For athletic-related hand and wrist conditions
• Physical medicine and rehabilitation physicians: For pain management and functional improvement
• Radiologists: May perform image-guided injections in complex cases
• Trained primary care physicians: May perform certain basic hand injections

Training and Expertise Considerations

The 2021 EULAR recommendations note that healthcare professionals performing intra-articular therapies have "varying levels of formal training" 1. This variation in training can impact outcomes, as proper technique is essential for effective treatment.

Research has identified concerning knowledge gaps between specialties. A study found that 70% of rheumatologists consider hand surgeons deficient in understanding medical options for rheumatoid arthritis, while 73.6% of surgeons believe rheumatologists have insufficient knowledge of surgical options 2. This highlights the importance of interdisciplinary communication when managing hand conditions.

Injection Techniques and Guidance

For most hand injections, ultrasound guidance is not mandatory but may be helpful for accurate placement 1. The technique varies based on the specific joint or structure being injected:

• For small joints: 2.5-5 mg of triamcinolone acetonide is typically used
• For larger joints: 5-15 mg is recommended 3

Proper aseptic technique is essential for all injections to prevent infection 3. The FDA label for triamcinolone acetonide emphasizes that "STRICT ASEPTIC TECHNIQUE IS MANDATORY" for all injections 3.

Common Hand Conditions Requiring Injection

1. Hand osteoarthritis: Intra-articular glucocorticoid injections are conditionally recommended 1
2. First carpometacarpal (CMC) joint osteoarthritis: May benefit from targeted injections 1, 4
3. De Quervain's tenosynovitis: Responds well to therapeutic injection 4
4. Trigger finger: Particularly beneficial in patients with diabetes or rheumatoid arthritis 4
5. Carpal tunnel syndrome: May be used diagnostically and therapeutically 4

Clinical Considerations and Cautions

• Injections should be limited to every third or fourth month to avoid tissue damage 5
• Avoid injecting directly into tendons or ligaments 5
• For diabetic patients, blood glucose monitoring after injection is important, though fewer than 10% of physicians make specific adjustments for diabetic patients 6
• For young athletes, careful consideration of risks and benefits is necessary 6

Interdisciplinary Approach

The evidence suggests that optimal management of hand conditions requiring injections benefits from collaboration between specialists. Unfortunately, research shows that only 62.4% of surgeons and 61.9% of rheumatologists communicate their concerns about management to the other specialty 2. This lack of communication may contribute to variations in care quality.

When seeking a provider for hand injections, patients should consider the specific condition being treated and the provider's experience with that particular injection technique.