A steroid injection into the wrist is a therapeutic option for acute or chronic capsulitis of the wrist joint, which can result from overuse or trauma.
The wrist capsule is not continuous; it is divided into separate compartments by septa. For this reason, a single injection site is not sufficient. The procedure typically requires multiple areas of infiltration through one entry point.
After the wrist injection, the patient rests in a splint until pain subsides. Then, gentle active and passive mobilization exercises begin within a pain-free range. Simple wax baths can be very soothing, and after removal from the hands, the wax can be used as an exercise ball. Heavy manual work should be limited.
This is a common site for wrist injections in patients with rheumatoid arthritis. If the joint is severely affected and swollen, it may be necessary to use a longer needle to reach the entire area or to inject at multiple sites. Patients with injuries from trauma, overuse, or osteoarthritis usually respond well to a short course of pain-relieving medication and rest in a splint. As with all trauma cases, a fracture, particularly of the scaphoid, must be ruled out.
Steroid injection into the distal radioulnar joint is used for chronic capsulitis or an acute meniscus tear.
The distal radioulnar joint is an L-shaped joint, roughly a finger’s breadth in length. It contains a triangular cartilage that separates the ulna from the carpus. With the palm facing down, the joint line lies directly medial to the bump at the end of the ulna, one-third of the way up from the wrist. The joint line is identified by gliding the ends of the radius and ulna against each other or by palpating the space between the ulnar styloid process and the triquetrum.
Rest for about one week is recommended, along with avoiding flexion and ulnar deviation activities. For meniscus tears, mobilization with distraction can be effective.
Cartilage tears are relatively common, especially after trauma such as a fall on an outstretched hand, a traction injury, or a Colles’ fracture. The most painful test is the scoop test, where the supinated wrist is compressed into ulnar deviation and scooped in a semi-circular motion toward flexion. Patients often report painful clicking and occasional locking of the wrist.
Mobilization of the radioulnar joint can help relieve pain, but in the acute phase, an injection combined with taping or splinting may be administered. Often, explaining the condition and providing reassurance, along with advice to avoid impact movements like turning a heavy steering wheel, performing handstands, or using a poor golf technique, is sufficient.
Disorders of the distal radioulnar joint (DRUJ) are rare but important causes of ulnar-sided wrist pain and disability. Fluoroscopy-guided injections can be used to diagnose or treat DRUJ-related pain or as part of a diagnostic arthrogram. Ultrasound guidance may be a favorable alternative to fluoroscopic guidance for distal DRUJ injections.
A randomized, prospective, single-blind study comparing palpation-guided versus ultrasound-guided corticosteroid injections and their short-term effects on distal radioulnar joint disorders found no significant difference in clinical outcomes between the group receiving US-guided injections and the group receiving palpation-guided injections. However, the US-guided intra-articular injection showed significantly higher accuracy than the palpation-guided injection in the DRUJ, and corticosteroid intra-articular injections effectively improved pain in patients with DRUJ disorders during the 6-month follow-up.
