Ultrasound-guided Basal Joint Injection: Does Experience Matter?
Jacob Tulipan, MD1; Kristin Sandrowski, MD2 Peter P. Pham, MS2; Amir Kachooei, MD3; Jonathan Shearin, MD1; Michael Rivlin, MD4
1Rothman Institute at Thomas Jefferson University, Philadelphia, PA; 2Thomas Jefferson University, Philadelphia, PA; 3Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran (Islamic Republic of); 4Rothman Institute, Philadelphia, PA
Introduction: The use of ultrasound-guided injections at the basal joint has increased in an attempt to improve accuracy. This study aimed to evaluate the utility of ultrasound guidance for basal joint injection using a model that takes into account the limited patient tolerance for painful procedures.
Materials and Methods: Two senior residents, two hand fellows and four attendings were selected as participants. All subjects underwent an introduction to ultrasound, given by an experienced ultrasound technologist instructor. Evaluation of subjects was performed on 10 fresh frozen cadaver hands with attached forearms. Each subject attempted to insert a 22 gauge needle into the basal joint, while being timed by a researcher. The subjects were instructed to attempt to keep injection time under 5 seconds, and were informed when 5 seconds elapsed from skin puncture. The process was repeated for all subjects using a 7.5 MHz linear probe. The time for needle placement and whether the needle was in the basal joint were recorded for all subjects. Confirmation of intraarticular placement of needle was by orthogonal fluoroscopic views evaluated by two blinded hand surgeons with a third surgeon as a tie-breaker.
Results: Intraarticular injections were accurately placed in 42% of palpation based injections (17/40) and 25% (10/40) of ultrasound-guided injections among all physicians. There was a significant difference in time for injection between the two groups, both with correctly and incorrectly placed injections (Figure 1). Ultrasound guidance increased the duration of time to needle placement compared to palpation for both properly sited injections (14.41 versus 6.15 seconds) and improperly sited injections (25.16 versus 5.85 seconds). There was no significant difference in accuracy or time between residents and attendings with or without ultrasound (Figure 2).
Conclusion: There was no significant difference between surgeons with different levels of training in accuracy with ultrasound-guided injections. Ultrasound guidance did not improve accuracy despite a short tutorial. Overall, for those without ultrasound experience, ultrasound-guided injections took significantly longer without improving accuracy.
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