An epidural steroid injection places this powerful anti-inflammatory medication directly around the spinal nerves. Traditionally epidural injections were administered without any special equipment, by inserting the needle by feel in the area around the spinal nerves. More recently epidural injections have been administered with the aid of imaging tools to allow your physician to see the needle going to the proper location. Either real-time x-ray called fluoroscopy, or CT scan can be used to 'watch' the needle deliver the medication to the proper location.
Sounds like they had a DeQuervain’s injection (if it’s intratendinous instead of just under the tendon sheath there can be a lot of resistance…especially if using a tuberculin syringe/needle), and then had either a trigger thumb injection or an intraarticular injection of the 1st carpometacarpal joint. Either way, they shouldn’t have had “nerve damage” from either injection. The “nerve damage” was probably already there. Without a pre- and post-injection EMG/NCS, it’s impossible to know for sure. The skin atrophy and other signs can be relatively common with kenalog and other insoluble steroids. I don’t what the “thumb locking” is unless the patient means trigger thumb. Some physicians will use sterile saline injections in the atrophied area to speed up the recovery.
Early trials of intra-articular corticosteroids showed equal systemic absorption of methylprednisolone in patients with rheumatic and osteoarthritic hands 42 and knees. 43 This suggests that steroid pharmacokinetics, rather than disease-related factors, should guide steroid selection. A recent review by the National Health Service of the United Kingdom 44 recommends triamcino-lone and methylprednisolone as preferred agents for injection of large joints (., knee). For smaller joints (., finger), either hydrocortisone or methylprednisolone (Hydeltrasol, brand no longer available in the United States) is recommended. Tables 5 and 6 45 compare commonly available steroid preparations.