A 47-year-old man with rheumatoid arthritis had restricted flexion of the middle finger, and occasionally the finger could not be extended after flexing. A thin needle is slowly inserted perpendicular to the tendon, and the patient is asked to flex the finger until the tip of the needle touches the surface of the tendon, making the syringe tilt forward during finger flexion (in the video this occurs at the second flexion). At this point, the needle is retracted about 1 mm, and the finger is flexed again to ascertain that the tip of the needle is not in the tendon any more. 1 ml of methyl prednisolone and bupivacaine is injected into the tendon sheath. When removing the needle, pinching the skin prevents the suspension from leaking under the skin. In severe tenosynovitis, another dose of the drug can be injected into the same tendon sheath through the skin of the palm 1 cm proximal from the skin groove at the base of the finger.
Injection for flexor tenosynovitis