Indications:

Circulatory disturbances, causalgia, post-traumatic osteoporosis of the upper extremity.

Materials:

Size 2 needle, 1 ml procaine or lidocaine.

Technique:

Point of insertion:

a: Palpate the artery a little above the antecubital fossa and inject intra- and para-arterially.

b: The artery can also be readily palpated in the axilla, where it issues from beneath the greater pectoral muscle and runs along the medial biceps groove.

Indications:

Circulatory disorders, cellulitis, abscesses, frostbite, burns to the upper extremity.

Materials:

40-mm-long needle, 2 ml procaine or lidocaine.

Technique:

Point of insertion: The pulsating artery can be palpated 10 mm above the mid-point of the clavicle.

As an alternative: stellate ganglion, brachial artery.

CAUTION: To avoid the risk of perforating the pleural apex, do not insert the needle further than 15 mm.

Indications:

All disorders in the region of the joint.

Materials:

Size 12 needle, 2 ml procaine or lidocaine.

Technique:

The patient lays the forearm on a table to form approximately a right angle between the forearm and upper arm.

Point of insertion: Midway between olecranon and lateral epicondyle.

Direction of needle: Toward the antecubital fossa.

Injection depth: Approximately 10–20 mm.

Indications:

Arthrosis, arthritis, post-traumatic joint disorders.

Materials:

Size 12 needle, 1 ml procaine or lidocaine.

Technique:

Point of insertion: Midway between the end of the ulna and the styloid process or between the distal end of the radius and the scaphoid bone.

Direction of needle: Perpendicular to the skin.

Injection depth: 5–10 mm.

Indications:

Arthrosis deformans, humeroscapular periarthritis, subacromial bursitis; conditions following contusion of the shoulder.

Materials:

40-mm-long needle, 2–5 ml procaine or lidocaine.

Technique:

Injection from the front:

Point of insertion: The patient lets the arm hang down, palm to the front; medially from the head of the humerus, the joint line can be palpated. The needle should enter just below the clavicle.

Direction of needle: Just below the acromion in an outward direction.

Injection depth: After overcoming the resistance from the ligaments, the needle slides easily into the joint.

Indications:

For disorders of the hand in the area supplied by this nerve; carpal tunnel syndrome.

Materials:

Size 12 needle, 1–2 ml procaine or lidocaine.

Technique:

a: In the antecubital fossa, the median nerve lies on the ulnar side of the palpable brachial artery.

b: Above the wrist.

Point of insertion: About three fingerbreadths above the line of the wrist joint, the nerve lies in a radial direction from the tendon of the palmaris longus muscle and is clearly visible in volar flexion of the hand.

Direction of needle, injection depth: Perpendicular to the skin until the patient reports paresthesia in the region supplied by this nerve.

Indications:

Disorders of the hand in the area supplied by the radial nerve.

Materials:

Size 12 needle, 1–2 ml procaine or lidocaine.

Technique:

a: The radial nerve is accessible above the elbow.

Point of insertion: About four fingerbreadths above the lateral epicondyle.

Direction of needle: Perpendicular to the skin.

Injection depth: If the needle’s position is correct, the patient reports electrifying pain in the thumb and the back of the hand.

Indications:

Disorders affecting the area supplied by this nerve, e. g., pain, vasospasm.

Materials:

Size 12 needle, 2 ml procaine or lidocaine.

Technique:

a: Point of insertion: The ulnar sulcus is palpable between the medial humeral epicondyle and the olecranon.

Direction of needle: Perpendicular to the skin.

Injection depth:

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