The Use of Digital Hand Sympathectomies for the Treatment of Ischemia and Pain Following Inadvertent Corticosteroid Injection of the Radial Artery: Two Case Reports

Abstract

Osteoarthritis of the carpometacarpal (CMC) joint of the thumb is commonly treated with intraarticular corticosteroid injections in clinic. In this case report, we present 2 patients who experienced immediate pain, pallor, and discoloration of their fingers distal to the site of attempted injection of the CMC joint of the thumb. It is believed that this occurred due to inadvertent injection of the dorsal branch of the radial artery as it branches to join both the superficial and deep palmar arches. This caused vasospasm and vasoocclusion leading to subsequent ischemia. To relieve symptomatic pain and prevent ischemic necrosis, both patients underwent sympathectomies of the radial and ulnar arteries and of the common palmar digital arteries. Both patients experienced relief of their pain and reperfusion of their hand and digits.