CT scan & Hyaluronate (Pod med) Flashcards
What are the clinical questions for the CT scan?
- ?
- ?
- ?
- ?
- ? - fibrous vs osseous
- ?
- ?
- ?
- Fracture
- Malunion
- Delayed union ( less than 6 months)
- Non-union (more than 6 months)
- Coalition
- Hardware
- Osteoarthritis
- Loose bodies
What does this image show?
It shows Tarsal Coalition
What does this image show?
Osteoarthritis of the the foot and ankle
What does this image show?
Osteoarthritis of the the foot and ankle
What does this image show?
Loose bodies (Red arrow)
Name some of the injections with CT guiadance?
- ?
- ?
- ?
- ?
CT useful to ensure 5?
6? injection first
- Cortisone
- Prolotherapy
- Platelet-rich plasme
- Hylanuric acid injection
- Intra-articular injection
- Contrast/Iodine
What are the 3 indications for cortisone injections?
1. ?
2. ?
3. ?
- Acute inflammation
- Chronic inflammation- degenarative OA
- Rheumatoid arthritis/ Spondyloarthropathy
Cortisone injection technique
1? preparation
Planning 2? to identify needle
Local Aneasthetic 3?
Correct position check 4?
Final injection 5?
- Sterile
- CT scan
- 3-5ml xylocaine
- first aspirate joint then inject 0.2ml iodine contrast
- mix of celestone, kenacort, dexamethasone
Hyalurenic acid injection
Mainly used in 1?
KL grade 2? and not grade 3?
Synvisc 4? and 5?
2 ml injections ideal for 6?
6ml injections ideal for 7?
- Knee OA
- grade 2-3 3 .4
- 2ml and 5. 6ml
- Ankle and subtalar
- Knee, Hip and shoulder
Synivisc (2ml)
1? to ensure all is 2?
Same principle as 3?
Safety profile similar
Watch for 4?
Risk of 5? if extra-articular
- CT guided 2. intra-articular
- Cortisone
- inflammatory syndrome
- Tissue damage
What is Hyaluronate:
a high molecular weight 1? is a principal component of 2?. It contributes to 3?
- polysaccharide
- synovial fluid and extracellular matrix of articular cartilage
- The elasticity and viscosity of synovial fluid
In addition to providing 1?hyaluronate helps to maintain the 2?
- joint lubrication and shock absorbancy
- structural and functional characteristics of the cartilage
matrix
What are the indications for viscosupplementation (Hyalurians):
1?
2?
3?
- Pt who have significant residual symptoms despite traditional nonpharmacologic and pharmacologic treatments
- patients who have gastrointestinal or renal intolerance to NSAIDs
- Postpone surgical interventions or are poor candidates for surgery
What are the Contraindications to hyaluronate injection:
1?
2?
3?
- Protein/Avian allergy
- Active skin disease
- Joint infection
What are the two different injection techniques:
1?
2?
- Anteriomedial
- Anteriolateral
Describe the anterior medial approach for injection?
the anterior medial approach, we position the patient in the 1? position, with 2?
The ankle is placed in a degree of 3?
We identify the space between 4? and palpate this space for the articulation of the talus and tibia to locate a suitable entry point into the ankle joint.
- supine
- the knee flexed and the foot flat on the examination table
- plantarflexion, which opens the anterior aspect of the joint
- The anterior border of the medial malleolus and the medial border of the tibialis anterior tendon
Describe the method for anterior lateral technique of injection:
Anterior lateral approach is done with the patient positioned with the foot in 1?.
The needle is inserted from the anterior lateral position and directed posteriorly toward the medial malleolus. The needle is advanced until there is a drop in tissue resistance confirming entry into the joint.
- plantar flexion
What are the common side effects of corticosteroid injections:
1?
2?
3?
4?
- Most common: Mild injection-site pain and swelling
- Rash
- Muscle cramps
- Dizziness, nausea, headache, local ecchymosis and pruritus.
