, Volume 10, Issue 2, pp 362–365 | Cite as

The “Thumbs-up” sign and trapeziometacarpal joint injection: a useful clinical indicator

  • Jason M. ErpeldingEmail author
  • Dimitryi Shnayderman
  • Dara Mickschl
  • Roger A. Daley
  • Steven I. Grindel
Multimedia Articles



Several clinical studies investigating the accuracy and efficacy of trapeziometacarpal injection exist. Some studies utilize anatomical landmarks for proper injection placement while others utilize modalities including ultrasound and fluoroscopy. The changes of limb position that occur at the time of intra-articular injection can provide valuable visual and tactile feedback to the clinician. The purpose of this study is to investigate the occurrence of the “Thumbs-up” sign with injection of the thumb trapeziometacarpal joint as a useful and reliable clinical indicator of intra-articular trapeziometacarpal injection and correlate level and duration of pain relief.


Trapeziometacarpal joint injections were performed on twenty-seven thumbs utilizing anatomic landmarks. At the time of injection, the presence or absence of the “Thumbs-up” sign was noted, and needle location was verified after injection with orthogonal mini-C arm fluoroscopic images. Visual analog pain scale scores were obtained pre-injection and by follow-up telephone calls at 1 week, 6 weeks, and 3 months post injection.


Twenty-four of twenty-seven injections demonstrated a positive “Thumbs-up” sign. There were three negative “Thumbs-Up” injections. The thumbs-up sign demonstrated a 92.3 % sensitivity. Eighteen of twenty-seven thumbs had sustained relief at 3 months post injection.


The “Thumbs-up” sign is a practical clinical tool that gives the practitioner important visual feedback at the time of injection. Patient relaxation and joint compliance are limiting factors. The “Thumbs-up” sign is an inexpensive indicator of successful intra-articular injection and may obviate the need and expense of advanced imaging modalities at the time of injection.


Thumbs-up sign Trapeziometacarpal joint Injection 



We kindly thank Shi Zhao, MS and Sergey Tarima, PhD of the Medical College of Wisconsin Department of Biostatistics for their assistance with data analysis.

Conflict of Interest

All authors declare that they have no conflict of interest.

Statement of Human and Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Statement of Informed Consent

Informed consent was obtained from all patients for being included in the study.

Supplementary material


(MP4 921 kb)


  1. 1.
    Day CS, Gelberman R, Patel AA, et al. Basal joint osteoarthritis of the thumb: a prospective trial of steroid injection and splinting. J Hand Surg [Am]. 2004;29(2):247–51.Google Scholar
  2. 2.
    Eaton RG, Glickel SZ. Trapeziometacarpal osteoarthritis: staging as a rationale for treatment. Hand Clin. 1987;3:455–71.PubMedGoogle Scholar
  3. 3.
    Eaton RG, Lane LB, Littler JW, et al. Ligament reconstruction for the painful thumb carpometacarpal joint: a long-term assessment. J Hand Surg. 1984;9A:692–9.Google Scholar
  4. 4.
    Haara MM, Heliövaara M, Kröger H, et al. Osteoarthritis in the carpometacarpal joint of the thumb. Prevalence and associations with disability and mortality. J Bone Joint Surg Am. 2004;86-A(7):1452–7.PubMedGoogle Scholar
  5. 5.
    Helm AT, Higgins G, Rajkumar P, et al. Accuracy of intra-articular injections for osteoarthritis of the trapeziometacarpal joint. Int J Clin Pract. 2003;57(4):265–6.PubMedGoogle Scholar
  6. 6.
    Khan M, Waseem M, Raza A, et al. Quantitative assessment of improvement with single corticosteroid injection in thumb CMC joint osteoarthritis? Open Orthop J. 2009;3:48–51.PubMedCentralPubMedGoogle Scholar
  7. 7.
    Maarse W, Watts AC, Bain GI. Medium-term outcome following intra-articular corticosteroid injection in first CMC joint arthritis using fluoroscopy. Hand Surg. 2009;14(2–3):99–104.PubMedGoogle Scholar
  8. 8.
    Mandl LA, Hotchkiss RN, Adler RS, et al. Can the carpometacarpal joint be injected accurately in the office setting? Implications for therapy. J Rheumatol. 2006;33(6):1137–9.PubMedGoogle Scholar
  9. 9.
    Meenagh GK, Patton J, Kynes C, et al. A randomized controlled trial of intra-articular corticosteroid injection of the carpometacarpal joint of the thumb in osteoarthritis. Ann Rheum Dis. 2004;63(10):1260–3.PubMedCentralPubMedGoogle Scholar
  10. 10.
    Pollard MA, Cermak MB, Buck WR, et al. Accuracy of injection into the basal joint of the thumb. Am J Orthop. 2007;36(4):204–6.PubMedGoogle Scholar

Copyright information

© American Association for Hand Surgery 2014

Authors and Affiliations

  • Jason M. Erpelding
    • 1
    • 2
    Email author
  • Dimitryi Shnayderman
    • 1
  • Dara Mickschl
    • 1
  • Roger A. Daley
    • 1
  • Steven I. Grindel
    • 1
  1. 1.Medical College of Wisconsin Department of Orthopaedic SurgeryMCW Clinics at Froedtert EastMilwaukeeUSA
  2. 2.Sanford Health, Orthopedics & Sports MedicineFargoUSA

Personalised recommendations