Dr. Moen and Kate Sarlette PA-C both use steroid injections therapeutically and diagnostically. Injections can reduce or eliminate symptoms so that further treatment is not needed for restoration of hand function. Injections can also confirm findings made during the clinical hand exam.

Introduction

Arthritis is a common source thumb, wrist or elbow pain. Synovial joints (like other joints in the body) allow for movement. When arthritis becomes significant enough, simple hand tasks such as buttoning a shirt, turning a car key or pushing up from a chair can create significant pain.

Goal of the injection

The goal of a joint injection is to place a small amount of steroid ( cortisone or corticosteroid) and local anesthetic in the inflamed joint. The injection can be used to diagnose or treat. The injected steroid serves as an anti-inflammatory medication, decreasing pain and improving the patient’s movement and activity.

Sometimes injections are used specifically to help diagnose where the pain may be coming from and can help determine if a patient would be a candidate for other treatments used to decrease painful joints.

Following a joint injection:

• Patients may resume activity as tolerated
• Patients may note an increase in inflammation in the area for a few days following the injection. 

Potential risk of the procedure

Joint injections are considered safe, non-surgical, minimally invasive treatments. As with all medical procedures, there associated risks and side-effects that may vary between each patient. These rare but potential risks are:

• Pain at the injection site.
• In very rare instances (less than 1%), minor infections can occur.
• Increased pain or worsening symptoms.
• If diabetic, you may notice a change in blood sugar levels following the injection.
• Allergic reactions to medications. The commonly used medications in this procedure include: Lidocaine, and corticosteroid (cortisone).

Introduction

Arthritis is a common source thumb, wrist or elbow pain. Synovial joints (like other joints in the body) allow for movement. When arthritis becomes significant enough, simple hand tasks such as buttoning a shirt, turning a car key or pushing up from a chair can create significant pain.

Goal of the injection

The goal of a joint injection is to place a small amount of steroid ( cortisone or corticosteroid) and local anesthetic in the inflamed joint. The injection can be used to diagnose or treat. The injected steroid serves as an anti-inflammatory medication, decreasing pain and improving the patient’s movement and activity.

Sometimes injections are used specifically to help diagnose where the pain may be coming from and can help determine if a patient would be a candidate for other treatments used to decrease painful joints.

Following a joint injection:

• Patients may resume activity as tolerated
• Patients may note an increase in inflammation in the area for a few days following the injection. 

Potential risk of the procedure

Joint injections are considered safe, non-surgical, minimally invasive treatments. As with all medical procedures, there associated risks and side-effects that may vary between each patient. These rare but potential risks are:

• Pain at the injection site.
• In very rare instances (less than 1%), minor infections can occur.
• Increased pain or worsening symptoms.
• If diabetic, you may notice a change in blood sugar levels following the injection.
• Allergic reactions to medications. The commonly used medications in this procedure include: Lidocaine, and corticosteroid (cortisone).

Introduction

Arthritis is a common source thumb, wrist or elbow pain. Synovial joints (like other joints in the body) allow for movement. When arthritis becomes significant enough, simple hand tasks such as buttoning a shirt, turning a car key or pushing up from a chair can create significant pain.

Goal of the injection

The goal of a joint injection is to place a small amount of steroid ( cortisone or corticosteroid) and local anesthetic in the inflamed joint. The injection can be used to diagnose or treat. The injected steroid serves as an anti-inflammatory medication, decreasing pain and improving the patient’s movement and activity.

Sometimes injections are used specifically to help diagnose where the pain may be coming from and can help determine if a patient would be a candidate for other treatments used to decrease painful joints.

Following a joint injection:

• Patients may resume activity as tolerated
• Patients may note an increase in inflammation in the area for a few days following the injection. 

Potential risk of the procedure

Joint injections are considered safe, non-surgical, minimally invasive treatments. As with all medical procedures, there associated risks and side-effects that may vary between each patient. These rare but potential risks are:

• Pain at the injection site.
• In very rare instances (less than 1%), minor infections can occur.
• Increased pain or worsening symptoms.
• If diabetic, you may notice a change in blood sugar levels following the injection.
• Allergic reactions to medications. The commonly used medications in this procedure include: Lidocaine, and corticosteroid (cortisone).

Introduction

Carpal tunnel syndrome is a cluster of symptoms produced when a nerve supplying the hand is compressed at the wrist level. Symptoms can include pain and tingling in the thumb, index, middle and ½ of the ring finger. Individuals may notice an increase in dropping items, decreased coordination or strength in their hand. symptoms may increase at night.

Goal of the injection

The goal of the injection is to place a small amount of steroid  medication in the carpal tunnel space to decrease inflammation within the tunnel in the wrist so that the median nerve has more room so there is less pressure on it and it can glide when the arm moves.

Sometimes injections are used specifically to help diagnose where the pain may be coming from and can help determine if a patient would be a candidate for other treatments used to decrease painful joints.

Following a carpal tunnel injection:

• Resume activity as tolerated
• Patients may note an increase inflammation in the area for a few days following the injection

Potential risk of the procedure

Carpal tunnel injections are considered safe, non-surgical, minimally invasive treatments. As with all medical procedures, there associated risks and side-effects that may vary between each patient. These rare but potential risks are:

• Pain at the injection site
• In very rare instances (less than 1%), minor infections can occur
• Increased pain or worsening symptoms.
• If diabetic, you may notice a change in blood sugar levels following the injection
• Allergic reactions to medications. The commonly used medications in this procedure include: Lidocaine, and corticosteroid (cortisone).

Introduction

Tennis elbow or lateral epicondylitis is common cause of elbow pain. It is caused due to irritation and poor healing of the wrist tendons as they attach to the lateral elbow. Tennis elbow is considered a self-limiting diagnosis in that most of the time the condition resolves itself in a year. The condition can recur. More recently, PRP injection for tennis elbow has become popular to attempt to speed healing. Your own blood is drawn and put into a centrifuge to separate the various types to blood cells and plasma. The plasma with platelets is injected back into the painful elbow.

Goal of the injection

The goal of a PRP injection is to speed up the healing process by using the patient’s own natural healing process to repair injured tissue.

Following a PRP injection

0-3 Days Post PRP Injection:

• It is recommended that the patient rests the day of the procedure. The next two days the patient should focus on limited use of the injected area. Gentle range of motion (movement) is recommended.
• Mild to moderate post-procedure pain can happen in the injected area. This is due to the inflammation at the injection site. Inflammation is the first stage of healing. The initial post procedure pain will typically resolve during the first few days after the procedure. You can take Tylenol as needed, per package recommendations.
• DO NOT TAKE anti-inflammatory medications such as Advil, Motrin, Ibuprofen, Aleve, Naproxen, Meloxicam, for at least two weeks after your procedure.
• DO NOT TAKE blood thinning herbs, supplements or vitamins for the first three to four days after your procedure.
• DO NOT TAKE systemic steroids such as Prednisone, Hydrocortisone, etc. for at least two weeks following your procedure (this plan will need to be discussed with your primary care provider prior to procedure).
• Avoid showering for 24 hours following your procedure.
• Do not consume alcoholic beverages for the first seven days following your procedure.
• Avoid smoking. Smoking delays healing and can increase the risk of complications.
• Drink at least 64 ounces of water daily to help you heal properly. Water does not mean tea, coffee, or soda. If you are on a diuretic medication (water pill) please drink what is allowable for you.

3-14 Days Post PRP Injection

• At this point you should gradually start increasing your daily activities and increase your exercise. To maximize the effects of the procedure, proper exercise is necessary.
• If you are still experiencing pain, continue you can take Tylenol as needed.
• No systemic steroids such as Prednisone, Hydrocortisone, etc. for at least two weeks following your procedure (per your designated plan).
• No anti-inflammatory medications such as Advil, Motrin, Ibuprofen, Aleve, Naproxen, Meloxicam for at least two weeks after your procedure.
• Hand therapy is offered for progressive range of motion of elbow and wrist as well as progressive forearm conditioning to maximize function

Potential risk of the procedure

Injections are considered safe, non-surgical, minimally invasive treatments. As with all medical procedures, there associated risks and side-effects that may vary between each patient. These rare but potential risks are:

• Pain at the injection site
• In very rare instances (less than 1%), minor infections can occur
• Increased pain or worsening symptoms.

Insurance Coverage

PRP injections are not typically covered by insurance. This is an out-of-pocket expense.

Introduction

If the fingers or thumb of the hand have become curled to the point where you can no longer flatten your palm on a table, you may be a candidate for a Xiaflex injection. Xiaflex is an injection of an enzyme that can break down the diseased tissue in the palm of that hand that is responsible for pulling fingers into the palm. The medication is injected into the diseased tissue and then the patient returns to the clinic in 2-3 days. At that time Dr. Moen will straighten the fingers and break the diseased cords.

Goal of the injection

The goal of a Xiaflex injection is to allow the surgeon to straighten the patient’s fingers without requiring surgery.

Following a Xiaflex injection

• Your hand will be wrapped in soft gauze or a band aide applied after the injection.
• It is recommended that you limit hand movement and keep the hand elevated for the first day after injection.
• Do not try to straighten the injected finger until your doctor tells you it is okay to do so.
• You will be asked to return to the clinic for Dr. Moen to manipulate or straighten you curled fingers.
• A custom hand splint will be made for you in hand therapy the day of the manipulation and you will be instructed in hand range of motion exercises and progressive functional activity
• A short duration of hand therapy may be offered to assist you in maximizing motion and function. If skin tearing occurs, hand therapy will provide scar management techniques.

Potential risk of the procedure

This medication is prescribed by Dr. Moen because she believes the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Common post injection side effects include:

• Pain
• Swelling
• Bruising
• Redness
• Itching at or around the injection site
• You may also experience swollen, painful areas in the elbow and underarm (swollen lymph nodes)

Serious side effects include:

• Signs of infection (such as fever, chills, increasing redness/swelling)
• Signs of nerve injury (such as numbness/tingling/pain/strange feeling in the treated hand)
• Feeling of dizziness.

At the time of the manipulation there may occur tears in the skin around the injection site (lacerations). If this occurs you will be instructed in how to care for the wound and wound care supplies with be provided to you

Rare side effects:

There is a possibility that the injection could cause a possibly permanent injury to the tendons/ligaments of the hand. The injury may require surgery to repair

Insurance Coverage

Our staff complete paperwork for the company that provides the medication and can guide you as you contact your insurance representative to determine your benefits regarding a Xiaflex injection.