What is the transthecal digital nerve block technique?

Updated: May 16, 2018
  • Author: Dmitry Volfson, DO; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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Originally described by Chiu in 1990, [7] this technique is also known as the flexor tendon sheath digital block. While treating trigger finger by injecting steroids and lidocaine into the tendon sheath, Chiu noted that anesthesia of the entire digit was achieved. Although adequate anesthesia is achieved with a single injection, this injection is painful because the needle pierces the very sensitive skin of the palm. Studies have shown that this type of block is as effective as traditional ring blocks in achieving adequate anesthesia. [8, 9, 10]

  • Place the patient’s hand on the sterile field with the palm up.

  • Locate the flexor tendon sheath by palpating it at the distal palmar crease.

  • Insert the needle at a 45-degree angle just distal to the distal palmar crease (see image below).

    Needle position for transthecal block. Needle position for transthecal block.
  • Inject the anesthetic, it should flow freely. If resistance is met, reposition the needle by slowly withdrawing it.

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