Injection for de Quervain tendinopathy

The hand is placed in a neutral position and turned on the side with the radial side up. The radial styloid and the first and second dorsal compartments are identified and marked. The injection site is between the two tendons of abductor pollicis longus (APL) and the extensor pollicis brevis (EPB), in the first dorsal wrist compartment. The best way to identify the landmarks is by getting the patient to extend and abduct the thumb. Prep the insertion site with iodine disinfectant or a chlorhexidine scrub. Using an aseptic technique, ethyl chloride is applied to the skin for anesthesia. Load the syringe with one-fourth to one-half mL of methylprednisolone (80 mg/mL) with 1 to 2 mL of lidocaine 1%. The needle should be aligned parallel to tendons of the APL and EPB, while aiming proximally towards the radial styloid (enter about 3/8 inch distal to the tip of the radial styloid). A 5/8-inch, 25 gauge needle is inserted at a 45-degree angle to a depth of 3/8 to 1/2 inch, flush against the periosteum of the radial styloid. Insert needle between the two tendons (do not inject into the tendon). There should be no resistance to injection flow. Moderate pressure to injection, a poorly distensible sac, or both may indicate chronic stenosis of the tendons.