Local injection for Dupuytren's contracture

The hand is placed in the palm up position. Ethyl chloride is sprayed on the skin for anesthesia. A 5/8 inch, 25-gauge needle is inserted vertically adjacent to the nodular thickening in the midline over the flexor tendon, to a depth of 1/4 to 3/8 inch. 1/2 mL lidocaine and 1/4 mL triamcinolone acetonide (40 mg/mL) are injected.