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The Diagnostic Utility of Midcarpal Anesthetic Injection in the Evaluation of Chronic Wrist Pain

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The evaluation of chronic wrist pain can be a diagnostic dilemma. Lidocaine injections combined with corticosteroids are often used for both diagnosis and therapy. The purpose of this study was to determine if a midcarpal injection of lidocaine could serve as a diagnostic tool in patients with chronic wrist pain. Specifically, the relationship of pain relief from the injection and improvement of grip strength were compared to the presence of intracarpal pathology as confirmed by wrist arthroscopy. Forty-five patients with chronic wrist pain underwent a midcarpal injection of lidocaine with or without corticosteroids. Forty of the 45 underwent comcomitant steroid injections; a majority of the 40 patients reported relief of pain for two or more weeks. Improvement of pain and improvement of grip strength were determined. Each of these patients subsequently underwent a radiocarpal and midcarpal arthroscopy, and the pathologic findings of arthroscopy were compared to the improvement of pain and grip strength. These data were compared to a cohort of six volunteers without history of wrist pain or trauma that underwent midcarpal injection of lidocaine. Statistical analysis was performed using Reciever-Operator-Characteristic analysis. The average age of patients with chronic pain was 30.3 years, with an average of 9.8 months of wrist pain. The ultimate diagnoses included 35 patients with carpal instability dissociative, two with nondissociative instability, seven with complex instability of the carpus, three with extensor carpi ulnaris tendonitis and one with deQuervain’s tenosynovitis. After lidocaine injection, the normal cohort had a mean loss of 2 kg (−5.3%) (p = 0.02) in grip strength, whereas the experimental cohort had a mean improvement in grip strength of 5.73 kg (34.4%). Improvement of pain after injection did not correlate with pathologic arthroscopic findings (p = 0.92). Improvement in grip strength after midcarpal lidocaine injection of 6 kg or 28% had a 73% sensitivity and a 70% specificity (p = 0.02) of having intracarpal pathology at the time of arthroscopy. Of the chronic wrist pain patients, only four had a normal arthroscopy, and the remainder had at least one area of significant pathology attributing to their pain. We conclude that a midcarpal injection of lidocaine can serve as an effective diagnostic tool in the evaluation of the patient with chronic wrist pain. Improvement of grip of 28% with or without relief of pain is highly correlated with intracarpal pathology.

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  1. Crawford RW, Ellis AM, Gie GA, Ling RSM. Intra-articular local anaesthsia for pain after hip arthoplasty. J Bone Jt Surg [Br] 1997; 79-B:796–800.

    Article  Google Scholar 

  2. Crawford RW, Gie GA, Ling RSM, Murray DW. Diagnostic value of intra-articular anaesthetic in primary osteoarthritis of the hip. J Bone Jt Surg [Am] 1998;80B:279–81.

    Article  Google Scholar 

  3. Cooney WP. Evaluation of chronic wrist pain by arthrography, arthroscopy and arthrotomy. J Hand Surg 1993;18A:815–22.

    Google Scholar 

  4. Garcia-Elias M. The treatment of wrist instability. J Bone Jt Surg [Br] 1997;79B:684–90.

    Article  Google Scholar 

  5. Geissler WB, Freeland AE, Savioe FH, McIntyre LW, Whipple TL. Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius. J Bone Jt Surg 1996;78A:357–65.

    Google Scholar 

  6. Geissler WB, Freeland AE, Weiss A-PC, Chow JYC. Techniques of wrist arthroscopy. J Bone Jt Surg 1999;81A:1184–97.

    Google Scholar 

  7. Hofmeister EP, Dao KD, Glowacki KA, Shin AY. The role of midcarpal arthroscopy in the diagnosis of disorders of the wrist. J Hand Surg 2001;26A:408–14.

    Google Scholar 

  8. Johnstone DJ, Thorogood S, Smith WH, Scott TD. A comparison of magnetic resonance imaging and arthroscopy in the investigation of chronic wrist pain. J Hand Surg 1997;22B:714–8.

    Google Scholar 

  9. Kato H, Nakamura R, Shionoya K, Makino N, Imaeda T. Does high-resolution MR imaging have better accuracy than standard MR imaging for evaluation of the triangular fibrocartilage complex? J Hand Surg 2000;25B:487–91.

    Google Scholar 

  10. Khoury NJ, El-Khoury GY, Saltzman CL, Branser EA. Intraarticular foot and ankle injections to identify source of pain before arthrodesis. AJR 1996;167:669–73.

    PubMed  CAS  Google Scholar 

  11. Neer CS II, Welsh RP. The shoulder in sports. Orthop Clin North Am 1977;8:583–91.

    PubMed  Google Scholar 

  12. Outerbridge RE. The etiology of chondromalacia patellae. J Bone Jt Surg 1961;43B:752–7.

    Google Scholar 

  13. Outerbridge RE. Further studies on the etiology of chondromalacia patella. J Bone Jt Surg 1964;46B:179–90.

    Google Scholar 

  14. Shin AY, Glowacki KA, Bishop AT. Dynamic axial carpal instability: a case report. J Hand Surg 1999:24A:781–5.

    Google Scholar 

  15. Viegas SF. Midcarpal arthroscopy: anatomy and technique. Arthroscopy 1992;8:385–90.

    Article  PubMed  CAS  Google Scholar 

  16. Weiss AP, Akelman E, Lambiase R. Comparison of the findings of triple-injection cinearthrography of the wrist with those of arthroscopy. J Bone Jt Surg [Am] 1996;78A:348–56.

    Google Scholar 

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Correspondence to Eric P. Hofmeister.

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The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.

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Bell, S.J., Hofmeister, E.P., Moran, S.L. et al. The Diagnostic Utility of Midcarpal Anesthetic Injection in the Evaluation of Chronic Wrist Pain. HAND 2, 39–45 (2007).

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