Document Detail

Sonographically guided hydrodissection and corticosteroid injection for scleroderma hand.
MedLine Citation:
PMID:  21234632     Owner:  NLM     Status:  MEDLINE    
Scleroderma is associated with intractable hand pain from vasospasm, digital ischemia, tenosynovitis, and nerve entrapment. This study investigated the effect of hydrodissection of the carpal tunnel followed by corticosteroid injection for the painful scleroderma hand. Twenty-six consecutive subjects [12 with painful scleroderma hand and 14 with rheumatoid arthritis and carpal tunnel syndrome (RA/CTS)] underwent sonographically observed carpal tunnel hydrodissection with 3 ml of 1% lidocaine administered with a 25-gauge 1-in. needle on a 3-ml RPD mechanical syringe (reciprocating procedure device). After hydrodissection, a syringe exchange was performed, and 80 mg of triamcinolone acetonide was injected. Baseline pain, procedural pain, pain at outcome, responders, therapeutic duration, and reinjection interval were determined. Hydrodissection and injection with corticosteroid significantly reduced pain scores by 67% in scleroderma (p < 0.001) and by 47% in RA/CT (p < 0.001). Scleroderma and RA/CTS were similar in outcome measures: injection pain (p = 0.47), pain scores at outcome (p = 0.13), responders (scleroderma, 83.3%; RA/CTS, 57.1%, p = 0.15), pain at 6 months (p = 0.15), and therapeutic duration (p = 0.07). Scleroderma patients responded better in time to next injection (scleroderma, 8.5 ± 3.0 months; RA/CTS, 5.2 ± 3.1 months, p = 0.03). Reduced Raynaud's attacks and healing of digital ulcers occurred in 83% of subjects. There were no complications. Hydrodissection with lidocaine followed by injection of triamcinolone reduces pain and vasomotor changes in the scleroderma hand. The mechanism may be a combination of hydrodissection-mediated mechanical freeing of entrapped arteries, nerves, and tendinous structures and corticosteroid-induced reduction of inflammatory vasospasm.
Suzanne L DeLea; Natalia R Chavez-Chiang; Janet L Poole; Hillary E Norton; Wilmer L Sibbitt; Arthur D Bankhurst
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2011-01-15
Journal Detail:
Title:  Clinical rheumatology     Volume:  30     ISSN:  1434-9949     ISO Abbreviation:  Clin. Rheumatol.     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-05-25     Completed Date:  2011-09-22     Revised Date:  2013-07-02    
Medline Journal Info:
Nlm Unique ID:  8211469     Medline TA:  Clin Rheumatol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  805-13     Citation Subset:  IM    
Division of Rheumatology, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA.
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MeSH Terms
Adrenal Cortex Hormones / administration & dosage,  therapeutic use*
Anesthetics, Local
Arthritis, Rheumatoid / drug therapy
Carpal Tunnel Syndrome / drug therapy
Dissection / methods*
Hand / ultrasonography*
Injections, Intra-Articular
Middle Aged
Outcome Assessment (Health Care)
Pain Measurement
Prospective Studies
Scleroderma, Localized / drug therapy*
Treatment Outcome
Triamcinolone Acetonide / administration & dosage,  therapeutic use*
Grant Support
R01 HL077422/HL/NHLBI NIH HHS; R01 HLO77422-01-A3//PHS HHS; UL1 TR000041/TR/NCATS NIH HHS
Reg. No./Substance:
0/Adrenal Cortex Hormones; 0/Anesthetics, Local; 137-58-6/Lidocaine; 76-25-5/Triamcinolone Acetonide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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