Evaluating Palpation Guided Injections in Trapeziometacarpal Arthritis
Evaluating Palpation Guided Injections in Trapeziometacarpal Arthritis
The objective of this study is to evaluate the accuracy of trapeziometacarpal injections
 using palpation alone. The importance of this study is one of education, cost containment,
 and decreased risk to the patient. If it can be shown that the accuracy of trapeziometacarpal
 injections using palpation alone is similar to the reported accuracy of ultrasound and
 fluoroscopy, then these guided techniques may not be needed.
The objective of this study is to evaluate the accuracy of trapeziometacarpal injections
 using palpation alone. If it can be shown that the accuracy of trapeziometacarpal injections
 using palpation alone is similar to the reported accuracy of ultrasound and fluoroscopy, then
 fluoroscopy and ultrasound guided techniques may not be needed. Due to the expenses
 associated with medications and testing, it is important to not accrue unnecessary costs if
 there is no perceived benefit. The investigators plan to enroll 50 patients presenting with
 trapeziometacarpal joint arthritis who agree to participate. These participants will undergo
 an injection technique consisting of palpating the base of the thumb and placing the needle
 into the trapeziometacarpal joint without the guidance of ultrasound or fluoroscopy. Contrast
 dye will be included in the standard injection of lidocaine and corticosteroid. After
 injection, the participant will have 2 fluoroscopy views of the thumb. The images will not be
 evaluated for injection accuracy prior to the patient leaving the clinic, so as to not
 introduce any bias by the treating physician. These images will be blindly reviewed by three
 investigators at a later date, and determined by consensus if there is contrast material in
 the joint. The accuracy rate can then be compared to data regarding accuracy of fluoroscopic
 and ultrasound guided injections of the trapeziometacarpal joint. If there is a similar
 accuracy rate between modalities, it can be concluded that ultrasound may not be worth the
 added cost to the patient and fluoroscopy may not be worth the added cost or radiation to the
 participant. Additionally, participants will be contacted at 6 weeks post injection to
 evaluate post-injection arthritis symptoms.
Inclusion Criteria:

 -  The patient has clinical signs of trapeziometacarpal arthritis and are willing to
 obtain a post injection x-ray

 -  The patient is over the age of 18 years of age.

 Exclusion Criteria:

 -  The patient has a known allergy to contrast dye

 -  The patient has a planned surgery on the trapeziometacarpal joint within 6 weeks
 following injection

 -  Patients who are pregnant or believe they may be pregnant

 -  Prisoners

 -  Patients who are unable to provide informed consent