BACKGROUND Corticosteroid injections are widely used for treating thumb carpometacarpal (CMC) arthritis, yet the accuracy of non-image-guided injections in expert hands is uncertain, with prior studies reporting intraarticular placement in about 60% of thumbs when performed by physicians with different levels of training. Despite their common use, there is a need to assess both the accuracy and the short-term clinical efficacy of these injections, particularly when performed without image guidance by fellowship-trained hand surgeons. QUESTIONS/PURPOSES (1) What is the accuracy of thumb CMC injections performed without image guidance by fellowship-trained hand surgeons in an office setting? (2) What is the short-term efficacy of thumb CMC injections performed without image guidance? METHODS We prospectively enrolled 33 patients with a mean ± SD age of 63 ± 12 years, 76% (25) of whom were female, with symptoms of basal joint arthritis that persisted despite conservative treatment, and we administered 1.5-mL corticosteroid injections without image guidance. We used descriptive statistics to analyze the outcomes, which included VAS, QuickDASH (Q-DASH), and Thumb Disability Examination (TDX) scores. Minimum clinically important differences (MCIDs) were defined as 0.9 points for the VAS, 18 points for Q-DASH, and 17 points for TDX. RESULTS Of the 33 injections analyzed, 79% (26) were intraarticular. At 6 weeks, patients reported a mean improvement of 22 points in QuickDASH, 24 points in TDX, and 4 points in VAS scores. Importantly, 73% (24 of 33), 55% (18 of 33), and 82% (27 of 33) of the patients achieved the MCID in the patient-reported outcomes, respectively, suggesting that even without image guidance, corticosteroid injections can provide effective short-term relief for thumb CMC arthritis. CONCLUSION We found that about 79% of injections were placed intraarticularly, which was comparable with the findings of previous studies using image guidance, and provided meaningful improvements in pain and function for 6 weeks. These findings suggest that for experienced fellowship-trained hand surgeons, non-image-guided injections remain a viable option. Future studies should explore long-term outcomes and the potential role of adjunctive treatments such as antiinflammatory medications and splinting to enhance patient care. LEVEL OF EVIDENCE Level II, therapeutic study.

中文翻译：

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由经验丰富的受过奖学金培训的手外科医生进行非图像引导的拇指基底关节注射的准确性和效果如何？


背景 皮质类固醇注射广泛用于治疗拇指腕掌骨 （CMC） 关节炎，但在专家手中进行非图像引导注射的准确性尚不确定，先前的研究报告称，当由不同培训水平的医生进行时，约 60% 的拇指关节内放置。尽管它们普遍使用，但需要评估这些注射的准确性和短期临床疗效，尤其是在没有由受过奖学金培训的手外科医生进行图像指导的情况下进行时。问题/目的 （1） 在办公室环境中，由受过专科培训的手外科医生在没有图像引导的情况下进行拇指 CMC 注射的准确性如何？（2） 在没有图像引导的情况下进行拇指 CMC 注射的短期疗效如何？方法 我们前瞻性招募了 33 例平均 ± SD 年龄为 63 ± 12 岁的患者，其中 76% （25） 为女性，尽管保守治疗后基底关节关节炎症状仍然存在，我们在没有图像引导的情况下进行了 1.5 mL 皮质类固醇注射。我们使用描述性统计来分析结局，包括 VAS、QuickDASH （Q-DASH） 和拇指残疾检查 （TDX） 评分。最小临床重要差异 （MCIDs） 定义为 VAS 为 0.9 分，Q-DASH 为 18 分，TDX 为 17 分。结果 在分析的 33 次注射中，79% （26） 是关节内注射的。6 周时，患者报告 QuickDASH 平均改善 22 分，TDX 平均改善 24 分，VAS 评分平均改善 4 分。 重要的是，73% （33 人中的 24 人） 、 55% （33 人中的 18 人） 和 82% （33 人中的 27 人） 的患者在患者报告的结果中分别达到了 MCID，这表明即使没有图像引导，皮质类固醇注射也可以为拇指 CMC 关节炎提供有效的短期缓解。结论 我们发现大约 79% 的注射是关节内进行的，这与以前使用图像引导的研究结果相当，并在 6 周内提供了有意义的疼痛和功能改善。这些发现表明，对于经验丰富的受过奖学金培训的手外科医生来说，非图像引导注射仍然是一个可行的选择。未来的研究应探讨长期结局和辅助治疗（如抗炎药物和夹板）对加强患者护理的潜在作用。证据级别 II 级，治疗研究。