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Updated: Sep 21, 2025

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Accuracy and Safety of Non-Image Guided Trigger Finger Injections: A Cadaveric Study.

Daniel D Binz1, Thomas W Mitchell1, Scott A Mitchell1

  • 1Baylor College of Medicine, Houston, TX, USA.

Hand (New York, N.Y.)
|June 3, 2022
PubMed
Summary

The mid-axial injection technique is the most accurate for treating stenosing flexor tenosynovitis without ultrasound guidance. This method ensures precise corticosteroid delivery into the flexor tendon sheath, minimizing risks.

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Area of Science:

  • Orthopedics
  • Hand Surgery
  • Anatomy

Background:

  • Stenosing flexor tenosynovitis (trigger finger) is often treated with corticosteroid injections.
  • Optimal non-ultrasound-guided injection techniques lack consensus in current literature.
  • Cadaver studies are crucial for evaluating anatomical injection accuracy and safety.

Purpose of the Study:

  • To compare the accuracy and safety of three common non-ultrasound-guided flexor tendon sheath injection techniques.
  • To identify the most effective technique for delivering corticosteroids into the flexor tendon sheath.
  • To assess the risk of tendon or digital nerve injury associated with each technique.

Main Methods:

  • A cadaver study involving 15 fresh-frozen hands (60 digits).
Keywords:
anatomybasic sciencediagnosisdigitspainresearch & health outcomesspecialtysurgerytendontreatment

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  • Digits were divided into three groups, each receiving injection via a different technique: palmar-to-bone, palmar supra-tendinous, or mid-axial.
  • Injections used methylene blue dye; subsequent dissection evaluated dye location and potential iatrogenic injury.

    • Main Results:

    • The mid-axial technique achieved the highest rate of intra-sheath injection (75%, 15/20 digits).
    • Palmar-to-bone technique resulted in the most combined intra- and extra-sheath injections (65%, 13/20 digits).
    • Palmar supra-tendinous technique yielded the most extra-sheath injections (45%, 9/20 digits); mid-axial technique had zero intra-tendinous injections.

    Conclusions:

    • The mid-axial injection technique is superior for non-image-guided flexor tendon sheath injections.
    • This technique offers the greatest accuracy for intra-sheath delivery and minimizes the risk of intra-tendinous injection.
    • Findings provide evidence-based guidance for clinicians performing trigger finger injections.