Picture of injection is misleading

EDITOR,—It is a pity that Michael Shipley's article on pain in the hand and wrist contains a misleading picture showing an injection on the radial side of the tendon in the carpal tunnel syndrome; it may put many doctors off trying this technique more than once.1 Unless the injection is given as described in the article the nerve may be damaged. The “ulnar bursa” of tenosynovium is the target and is conveniently situated halfway between two palpable bony landmarks (the tuberosity of the scaphoid and the pisiform) or, as stated, to the ulnar side of the palmaris tendon.

Generally, orthopaedic surgeons see these patients and have the advantage of visualising the deeper structures. Thus for trigger fingers or thumb they know that they have to inflate the tendon sheath in the finger rather than inject “around” the module. They also know how low the cure rate is for ganglions treated by aspiration (popping them is better). It might be a good idea to mention that the nodule in De Quervain's tenosynovitis may be bony hard and puzzles young doctors.