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Sonographically guided hydrodissection and corticosteroid injection for scleroderma hand

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Abstract

Scleroderma is associated with intractable hand pain from vasospasm, digital ischemia, tenosynovitis, and nerve entrapment. This study investigated the effect of hydrodissection of the carpal tunnel followed by corticosteroid injection for the painful scleroderma hand. Twenty-six consecutive subjects [12 with painful scleroderma hand and 14 with rheumatoid arthritis and carpal tunnel syndrome (RA/CTS)] underwent sonographically observed carpal tunnel hydrodissection with 3 ml of 1% lidocaine administered with a 25-gauge 1-in. needle on a 3-ml RPD mechanical syringe (reciprocating procedure device). After hydrodissection, a syringe exchange was performed, and 80 mg of triamcinolone acetonide was injected. Baseline pain, procedural pain, pain at outcome, responders, therapeutic duration, and reinjection interval were determined. Hydrodissection and injection with corticosteroid significantly reduced pain scores by 67% in scleroderma (p < 0.001) and by 47% in RA/CT (p < 0.001). Scleroderma and RA/CTS were similar in outcome measures: injection pain (p = 0.47), pain scores at outcome (p = 0.13), responders (scleroderma, 83.3%; RA/CTS, 57.1%, p = 0.15), pain at 6 months (p = 0.15), and therapeutic duration (p = 0.07). Scleroderma patients responded better in time to next injection (scleroderma, 8.5 ± 3.0 months; RA/CTS, 5.2 ± 3.1 months, p = 0.03). Reduced Raynaud’s attacks and healing of digital ulcers occurred in 83% of subjects. There were no complications. Hydrodissection with lidocaine followed by injection of triamcinolone reduces pain and vasomotor changes in the scleroderma hand. The mechanism may be a combination of hydrodissection-mediated mechanical freeing of entrapped arteries, nerves, and tendinous structures and corticosteroid-induced reduction of inflammatory vasospasm.

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Disclosures

There was no industry support for this research. All devices and drugs were purchased, not donated to this study. Drs. Chavez-Chiang, Norton, DeLea, and Poole have no disclosures. Dr. Bankhurst is funded by a research grant from the Robert Wood Johnson Foundation. Dr. Wilmer L. Sibbitt, Jr. is funded by research grant RO1 HLO77422-01-A3 from the US National Institutes of Health and is an employee of the University of New Mexico. Dr. W. Sibbitt also is an expert consultant for Becton Dickinson, Inc., Intelligence Management Solutions, Inc., Ferring Pharmaceuticals, Inc., Avanca Medical Devices, Inc., Avasca Medical, Inc., and MediTech Duopross, Inc. Dr. Sibbitt holds stock in Apple Inc., Celgene Corp, Inc., Avanca, Inc., Avasca, Inc., Sun Microsystems, Inc, Symantec Corp., and Java, Inc. In the preceding 12 months, Dr. Sibbitt has had four patents acquired by Abbott Vascular, Inc., but these patents do not relate to the present research.

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Authors and Affiliations

  1. Division of Rheumatology, Department of Internal Medicine, University of New Mexico Health Sciences Center, 5th FL, ACC, Albuquerque, NM, 87131, USA

    Suzanne L. DeLea, Natalia R. Chavez-Chiang, Hillary E. Norton, Wilmer L. Sibbitt Jr. & Arthur D. Bankhurst

  2. Division of Occupational Therapy, Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, 87131, USA

    Janet L. Poole

  3. Internal Medicine and Neurology, University of New Mexico Health Sciences Center, MSC 10 5550, 5th FL ACC, Albuquerque, NM, 87131, USA

    Wilmer L. Sibbitt Jr.

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  1. Suzanne L. DeLea
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  2. Natalia R. Chavez-Chiang
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  5. Wilmer L. Sibbitt Jr.
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Correspondence to Wilmer L. Sibbitt Jr..

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DeLea, S.L., Chavez-Chiang, N.R., Poole, J.L. et al. Sonographically guided hydrodissection and corticosteroid injection for scleroderma hand. Clin Rheumatol 30, 805–813 (2011). https://doi.org/10.1007/s10067-010-1653-6

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