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Can the Carpometacarpal Joint Be Injected Accurately in the Office Setting? Implications for Therapy
LISA A. MANDL, ROBERT N. HOTCHKISS, RONALD S. ADLER, LILY A. ARIOLA, and JEFFREY N. KATZ ABSTRACT. Objective. To investigate whether carpometacarpal (CMC) injections can be performed accurately in the office setting in patients with moderate to severe CMC osteoarthritis (OA). Methods. Patients were recruited from rheumatology and hand surgical practices as part of an open label trial of hylan G-F 20 for CMC OA. CMC injections were performed without radiologic guidance, using anatomic landmarks to guide needle placement. Once injected, the patient was immediately taken to an adjacent ultrasound suite, and the injected CMC joint examined for evidence of intraarticular material and air microbubbles. Results. Thirty-two patients were injected. All patients had ultrasound evidence of intraarticular material: 91% also had evidence of microbubbles in the joint. Conclusion. CMC injections can be performed accurately in the office setting, without the need for radiologic guidance, in patients with moderate to severe CMC OA. (J Rheumatol 2006;33:1137–9) Key Indexing Terms:
OSTEOARTHRITIS
From the Departments of Medicine, Orthopedics, and Radiology and Imaging, Hospital for Special Surgery, New York, New York; Division of Rheumatology and Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA. Supported in part by grants from Wyeth Pharmaceuticals and Genzyme Corporation. Dr. Mandl is supported by NIH K23 AR050607-01. Dr. Katz is supported by NIH P60 AR 47782; NIH K24 02123. L. Mandl, MD, MPH, FRCPC, Assistant Professor of Medicine; R. Hotchkiss, MD, Associate Professor of Surgery (Orthopedics); R. Adler, MD, PhD, Professor of Radiology; L.A. Ariola, RN, Clinical Research Coordinator, Orthopedic Hand Service, Weill Medical College of Cornell University; J. Katz, MD, MS, Associate Professor of Medicine and Orthopedic Surgery, Division of Rheumatology, Immunology and Allergy, Harvard Medical School. Address reprint requests to Dr. L. Mandl, 535 East 70th Street, New York, New York, 10021. Accepted for publication January 22, 2006.
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