Intermetacarpal Blocks

  • Safer than digital blocks because they cause less disruption to venous outflow.
  • 2 – 3mls of plain 2% Lignocaine for each finger then get patient to massage the area.
  • Only 1 injection is required per finger.
Anatomy
  • Note relative safe zone over flexor sheath.
  • Nerves are largely Volar.
    • the dorsal cutaneous nerves are variable and may supply up to and just beyond the PIP joint. Hence if an anaesthetic block is required for the PIP joint it may need to be supplemented with dorsal infiltration proximal to the finger.

  • Aim to inject superficial to flexor sheath.
  • The local anaesthetic will leak around the adjacent common digital nerves.
  • If the needle moves with finger ROM it is in the tendon!!!

  • Massage the area to speed up onset of the block.

For further information, refer to Hand Injections – General and Trigger Finger Injections.

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