Single Injection Digital Block: Is a Transthecal Injection Necessary?

2009 ◽  
Vol 34 (1) ◽  
pp. 94-98 ◽  
Author(s):  
M. SONOHATA ◽  
A. ASAMI ◽  
K. OGAWA ◽  
S. NAGAMINE ◽  
T. HOTOKEBUCHI
Keyword(s):  
Subcutaneous Injection ◽  
Flexor Tendon ◽  
Anaesthetic Agent ◽  
Single Injection ◽  
Tendon Sheath ◽  
The Other ◽  
Injection Technique ◽  
Subcutaneous Space ◽  
Flexor Tendon Sheath ◽  
Digital Block

Three different methods of injection to obtain digital block anaesthesia were performed on 15 healthy volunteers to evaluate the success and extent of anaesthesia. We found that the traditional transthecal injection technique was inaccurate and the injected agent mainly flowed into the subcutaneous space, and did not remain within the sheath. The deep transthecal single injection kept the anaesthetic agent within the flexor tendon sheath, as intended. The duration of anaesthesia and the area anaesthetised by the subcutaneous injection and the traditional transthecal injection was similar and satisfactory. However, the anaesthetic area after the deep transthecal injection was significantly smaller than that of the other two techniques ( P<0.01). A transthecal digital block offers no advantage over a simple subcutaneous digital block.

Epithelial inclusion cyst of the equine digital flexor tendon sheath: diagnosis by ultrasonography and magnetic resonance and successful treatment by tenoscopy

2019 ◽  
Vol 88 (6) ◽  
pp. 320-326 ◽  
Author(s):  
Z. Joostens ◽  
L. Vanslambrouck ◽  
H. De Cock ◽  
T. Mariën
Keyword(s):  
Magnetic Resonance ◽  
Flexor Tendon ◽  
Surgical Excision ◽  
Tendon Sheath ◽  
Good Prognosis ◽  
Inclusion Cyst ◽  
Flexor Tendon Sheath ◽  
Dense Mass ◽  
Epithelial Inclusion Cyst ◽  
Distal Aspect

A six-year-old warmblood horse was presented with a longstanding frontlimb lameness with mild digital flexor tenosynovitis and swelling of the distomedial pastern. Ultrasonography and magnetic resonance revealed a dense mass lesion in the distal aspect of the digital flexor tendon sheath, with a partial lamellar architecture, absence of internal vascularization and adjacent smooth pressure osteolysis of the middle phalanx. After surgical excision, histopathology confirmed an epithelial inclusion cyst. Epithelial inclusion cysts, also known as keratinizing or follicular cysts, are expansile benign mass-like lesions of aberrant epidermal tissue. In the horse, they are known to occur in cutaneous and several non-cutaneous tissues. In the digital flexor tendon sheath, they have rarely been described. Given their often chronic presentation in this location, they may appear as an atypical dense mass on imaging, uncommon for cystic lesions. Complete tenoscopic removal, even for larger masses, is achievable and considered curative with good prognosis for return.

Transthecal Digital Nerve Block

1998 ◽  
Vol 23 (4) ◽  
pp. 490-493 ◽  
Author(s):  
N. S. SARHADI ◽  
J. SHAW-DUNN
Keyword(s):  
Methylene Blue ◽  
Nerve Block ◽  
Flexor Tendon ◽  
Proximal Phalanx ◽  
Proximal Part ◽  
Tendon Sheath ◽  
Areolar Tissue ◽  
Digital Nerve ◽  
Flexor Tendon Sheath ◽  
Digital Nerve Block

Injection studies using methylene blue and latex were used in 60 digits from 40 cadavers to study how anaesthetic fluid injected into the flexor tendon sheath might spread around the proximal part of the finger. The injected solution escaped from the flexor tendon sheath around the vincular vessels which are present near the base and head of the proximal phalanx. Outside the digital canal, the dye flowed smoothly through the perivascular loose areolar tissue and spread alongside the main digital vessels and nerves and their palmar and dorsal branches.

The Sesamoids of the Metacarpo-Phalangeal Joint of the Thumb: An Anatomical and Clinical Study

1989 ◽  
Vol 14 (2) ◽  
pp. 244-247
Author(s):  
J. D. GIBEAULT ◽  
P. SABA ◽  
H. HOENECKE ◽  
A. GRAHAM
Keyword(s):  
Clinical Study ◽  
Flexor Tendon ◽  
Tendon Sheath ◽  
Volar Plate ◽  
Histological Studies ◽  
Anatomical Dissection ◽  
Flexor Tendon Sheath

Two unusual cases of injury to the sesamoids of the M.P. joint of the thumb are described. An anatomical dissection of the M.P. volar plate region, including the sesamoids, was undertaken to delineate the details of the sesamoids’ relationship to the M.P. joint, flexor tendon, flexor tendon sheath and capsule of the joint. Histological studies were carried out to demonstrate a tendinous extension of the muscles that attach to the sesamoids.

scholarly journals Reducing Patient Discomfort during Digital Blockade: The Subcutaneous Single Injection Digital Block – A Simple, Safe and Fast Procedure

2003 ◽  
Vol 11 (1) ◽  
pp. 33-35 ◽  
Author(s):  
JP Brutus ◽  
A Nikolis ◽  
Y Baeten ◽  
N Chahidi ◽  
L Kinnen ◽  
...  
Keyword(s):  
Single Injection ◽  
Proximal Phalanx ◽  
Injection Technique ◽  
Dorsal Aspect ◽  
Single Finger ◽  
Volar Aspect ◽  
Tolerance Distribution ◽  
A Prospective Study ◽  
Fast Procedure ◽  
Digital Block

Background Regional anesthesia of a single finger is commonly achieved by the traditional ring block, which requires at least two painful injections in the digit. Single injection digital block techniques have been described to avoid this problem. Among these, the subcutaneous technique described by Harbison appears to be safe and to allow most procedures to be carried out with good tolerance. Objectives A prospective study was designed to evaluate the results of the subcutaneous technique in terms of patient tolerance, distribution of anesthesia and efficiency. Methods All blocks were performed by a single investigator. A visual analog scale was used to evaluate pain associated with the injection. Prick testing was used to evaluate the quality of anesthesia at the volar and dorsal aspects of the phalanxes. Tolerance to the surgical procedure and the need for additional injections were also recorded. Results This technique allowed surgery to be performed without complementary injection most of the time and was very well tolerated. The dorsum of the proximal phalanx, however, was unpredictably included in the anesthetized territory. Conclusion The subcutaneous single injection digital block is safe, efficient and easy to perform. It allows the treatment of all conditions on the volar aspect of the finger and on the dorsal aspect of the distal and middle phalanxes. For surgery on the dorsal aspect of the proximal phalanx, a combined single injection technique or a supplementary dorsal block should be used.

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