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When to avoid injection If there is wasting of the thenar muscles If permanent sensory loss These cases need surgery to prevent progression of the neuropathy Local or systemic infection Risks and complications Skin depigmentation, dermal atrophy, adipose atrophy, particularly if injection too superficial Flare of symptoms Increased blood sugars in diabetic patients, this may last for 3-7 days with significant elevation of blood sugars Facial flushing particularly in ladies Equipment Antiseptic spray spray ( alcoholic chlorhexidine) , dressings/ plaster for after injection, gloves

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Six cysteines forming three disulfide bridges are shown