A 61-year-old woman with rheumatoid arthritis had morning stiffness and restricted flexion of the fingers (normally the fingertips touch the palm when the fingers are flexed while the MCP joints are held straight). See also video . A mixture of methylprednisolone and bupivacaine is injected into the most affected tendon sheath. Before the injection the patient is asked to flex the finger. If the tip of the needle is in the tendon, the needle and syringe tilt - if tilting is observed the tip must be retracted from the tendon before injection. No resistance should be felt during injection. See also video .
Flexor tenosynovitis in rheumatoid arthritis