What does the palmar/plantar digital nerve block do?
- 70 to 80% foot including sole - most of DIPJ - 2-4ml per site
What does the palmar/plantar abaxial nn block do?
- foot and pastern - 2-4ml per site
What are the approaches for the DIP block?
a. dorsal midline approach b. approach lateral/medial to extensor tendon c. palmar/ plantar approach
What are the approaches to block the navicular bursa?
- midline - navicular horizontal approach - midline - navicular 30 degrees oblique approach - lateral palmar/plantar approach
What are the 2 approaches to the PIPJ block?
- dorsal approach (abaxial to extensor tendon, level of palmar process P1) - palmar/plantar approach (v shaped notch)
How can you do a low palmar/plantar nerve block?
- palmar/ plantar metacarpal/ metatarsal nerve - palmar/ plantar nerve (avoid DFTS!) - dorsal SC ring block (skin sensation, HL)
Where do you do a palmar digital nerve block (PDNB)?
Palpate the neurovascular bundle just proximal to the collateral cartilage of P3. The palmar digital nerve (PDN) lies most palmar. AIM DISTALLY
How do you do a Palmar or plantar abaxial sesamoid nerve block (ASNB)?
Palpate the neurovascular bundle at the level of the base of the proximal sesamoid bones. The palmar digital nerve lies most palmar (structures from dorsal to palmar: vein – artery- nerve). AIM DISTALLY
How do you do a low 4 point block?
- Palmar nerve: Inject subcutaneously between the DDFT and the SL. - Palmar metacarpal nerve: Inject below the level of the button of the splint bone.
How do you do a DIPJ block?
Insert a needle on the midline, 1cm proximal to coronary band, aim slightly distal to perpendicular. The needle should penetrate the dorsal pouch of the joint which extends proximally to about the centre of the middle phalanx.