PATIENT POSITION

Supine on the examination table with the head of the bed elevated 30 degrees.
The wrist is held in pronation.
The hand is supported with the placement of chucks pads or towels.
Rotate the patient’s head away from the side that is being injected. This minimizes anxiety and pain perception.

LANDMARKS

1. With the patient supine on the examination table, the clinician stands lateral to the affected hand.

2. Identify the cystic structure over the dorsal aspect of the finger, just proximal to the nailfold.

3. The injection point is located directly over the cyst.

4. The patient should not move the hand.

ANESTHESIA

Digital block anesthesia of the finger using injected 1% lidocaine.

EQUIPMENT

3-mL syringe
18-gauge, 1½ in. needle
One alcohol prep pad
Two povidone–iodine prep pads
Sterile gauze pads
Sterile adhesive bandage
Nonsterile, clean chucks pad

TECHNIQUE

1. Achieve good digital block anesthesia.

2. Prep the insertion site with alcohol followed by the povidone–iodine pads.

3. Position the needle and syringe perpendicular to the skin with the needle tip directed to the center of the cyst.

4. Using the no-touch technique, introduce the needle at the insertion site (Fig. 6.56).

5. Advance the needle quickly but carefully into the cyst.

6. Apply suction with the syringe and withdraw the expected small amount of a clear gel.

7. Withdraw the needle.

8. With either the shaft of the needle or gloved fingers, apply firm pressure to the tissues surrounding the punctured cyst. Remove all extruded clear gel with sterile gauze pads (Fig. 6.57).

9. Injection of steroid solution is not indicated.

10. Apply a sterile adhesive bandage.