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Ultrasound-guided injection of the pisotriquetral joint: technique and case series

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Abstract

Purpose

To describe our techniques for ultrasound-guided injection of the pisotriquetral joint (PTJ), and to report our experience in a case series.

Methods

Between 7/1/14 and 11/30/20, we performed 42 injections in 33 patients with ulnar-sided wrist pain, referred by clinicians who suspected the PTJ as the pain generator. There were 16 males and 17 females, average age 46.7 years. The patients were positioned in one of five ways: sitting with the hand maximally supinated; sitting with the hand maximally pronated; supine with the elbow flexed across the chest and the ulnar aspect of the wrist facing upward; supine with the elbow flexed, the arm externally rotated, and the ulnar aspect of the wrist facing upward; prone with the symptomatic hand at their side and the ulnar aspect of the wrist facing upward.

Results

The procedures were performed by any of twelve fellowship-trained musculoskeletal radiologists. Fifteen patients reported immediate relief of symptoms, including 6 patients whose pisotriquetral joints were normal sonographically. Four patients underwent subsequent surgical excision of their pisiforms and the fifth underwent arthroscopic debridement of the pisotriquetral joint.

Conclusion

Ultrasound is a facile imaging modality for guiding pisotriquetral injections, which may be accomplished with a variety of patient positions and injection techniques.

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Authors and Affiliations

  1. Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70th Street, New York, NY, 10021, USA

    Theodore T. Miller & Giorgios Bis

  2. Department of Radiology, William Beaumont Hospital, Royal Oak, MI, 48073, USA

    Giorgios Bis

Authors
  1. Theodore T. Miller
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  2. Giorgios Bis
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Contributions

Both Dr. Miller and Dr. Bis have contributed to all four categories of manuscript contribution:

  1. Both authors were involved with conception/design of the project, and acquisition and analysis of the data.

  2. Both authors were involved with drafting of the manuscript.

  3. Both authors have approved the submitted version of the manuscript.

  4. Both authors agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Theodore T. Miller.

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The authors declare no competing interests.

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Miller, T.T., Bis, G. Ultrasound-guided injection of the pisotriquetral joint: technique and case series. Skeletal Radiol 51, 1687–1694 (2022). https://doi.org/10.1007/s00256-022-03992-z

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  • DOI: https://doi.org/10.1007/s00256-022-03992-z

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