Interphalangeal joint injection is used as a therapeutic procedure to treat inflammation of the metacarpal phalangeal and interphalangeal joints due to rheumatoid arthritis and other inflammatory arthritides.
After informed consent is obtained, the patient is placed in the sitting position with the arm resting on the examination table. The hand is placed with the joint extended for approach from the lateral or medial aspect, with slight traction applied to the finger. The patient is prepared in a standard aseptic fashion over an area large enough to allow palpation of landmarks, and sterile technique is used throughout the procedure. A 1-in. (2.5-cm), 25- to 27-gauge needle is inserted at the borders of the joint and advanced gently to the joint capsule. Pericapsular injection without attempting to enter the joint is appropriate. The pericapsular area is injected with a 1-mL mixture of 10 mg of triamcinolone acetonide (or equivalent) and local anesthetic (Fig. 67-46).
FIGURE 67-46. Interphalangeal joint injection. Approach for first metacarpal joint aspiration and injection.
No effort should be made to aspirate fluid unless infection is suspected.
Serious complications are uncommon with appropriate needle placement.