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Am Fam Physician. 2024;110(4):402-410

This is one of a series of articles produced in collaboration with the American Medical Society for Sports Medicine.

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Family physicians are well-positioned to provide injections for patients who have wrist pain, especially when initial treatments such as nonsteroidal anti-inflammatory drugs and rest fail. Although corticosteroid injections can offer pain relief, possible risks (e.g., infection, cartilage damage, skin depigmentation) should be discussed. Techniques and procedures for injections vary. Studies have shown significant improvement in carpal tunnel syndrome severity over 12 weeks using ultrasound-guided injections compared with landmark-guided injections. Ganglion cyst aspiration can be helpful for patients with significant symptoms, although more than 50% of ganglion cysts may recur within a year. Corticosteroid injections of ganglion cysts do not appear to produce additional benefits to aspiration. Intersection syndrome is an overuse injury; management involves rest, adjustment of activities, use of braces, nonsteroidal anti-inflammatory drugs, and physical or occupational therapy. For symptoms not improved by these methods, an ultrasound-guided glucocorticoid injection may be administered. Treatment options for a triangular fibrocartilage complex injury include immobilization, kinesio taping, relative rest, and analgesics; corticosteroid injection may relieve acute inflammatory pain. De Quervain tenosynovitis is treated conservatively with palpation- or ultrasound-guided corticosteroid injection, splinting, occupational therapy, and activity modification.

The hand and wrist complex—comprising 27 bones and multiple tendons, muscles, ligaments, and nerves—is integral for performing daily tasks. Injury to any part of the complex can have a major effect on functional activities of daily living. Hand and wrist injuries represent 25% of all sports-related injuries, and the number is rising.1 Part II of this series on injections of the hand and wrist addresses diagnostic and therapeutic approaches, with or without ultrasound guidance, to conditions affecting the wrist, including carpal tunnel syndrome (CTS), ganglion cyst, intersection syndrome, triangular fibrocartilage complex injury, and de Quervain tenosynovitis. Part I addresses injections for the hand, including trigger finger, first carpometacarpal joint osteoarthritis, and palmar fibromatosis.2

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