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Ortho > Injections > Flashcards

Injections Flashcards

1
Q

Indications for Injections

A 
Osteoarthritis
Rheumatoid arthritis
Gouty Arthritis
Synovitis
Bursitis
Tendonitis
Muscle trigger points
Carpal tunnel syndrome
Wound anesthesia
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2
Q

Describe Local Infiltration

A

Injecting into the subcutaneous tissue of open wounds

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3
Q

How to clean & sterilize the wound?

A

Clean it enough
Perform injection
Scrub the skin

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4
Q

What medication decreases blood loss?

A

Epinephrine

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5
Q

Describe a Field Block

A

Inject a diamond around the wound

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6
Q

How does one perform a field block?

A

Skin prep
Inject slowly while advancing the needle
Pull needle almost out and switch directions
Repeat on other side

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7
Q

How to Perform a Digital Block

A

Start dorsally

Go down proximal phalynx

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8
Q

Caution with Digital Blocks

A

Use of epinephrine

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9
Q

Indication for Trigger Point Injections

A

Inflamed tendon or bursa by a bony prominence

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10
Q

What ortho issue has pain with resisted wrist dorsiflexion?

A

Tennis elbow

Lateral epicondylitis

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11
Q

What ortho issue has pain with stretching of the lateral side of hip?

A

Greater trochanteric bursitis

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12
Q

What is ischial tuberosity bursitis due to?

A

Prolonged sitting

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13
Q

What ortho issue has pain with resisted flexion?

A

Ischial tuberosity bursitis

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14
Q

Aftercare for an Injection

A

Rest
Ice
Anti-inflammatories
Resume conservative stretching

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15
Q

Why inject joints?

A

Inflammation

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16
Q

Inflammatory Conditions that Benefit from Injections

A

DJD
Bursitis
Tendonitis

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17
Q

How does corticosteroid injections help decrease inflammatory reactions?

A

Limit capillary dilatation

Vascular permeability

18
Q

Risks of Joint Injections

A 
Infections in healthy patients
Soft tissue inflammation
Acceleration of a septic joint
SubQ atrophy & skin depigmentation
Steroid flare
Exacerbation of Dm
Cartilage damage
Tendon rupture
Allergic reaction
Anaphylactic reaction
19
Q

Describe a Steroid Flare

A

Facial flushing
First 24-48 hours
Clears in 1-2 days

20
Q

Contraindications for Injections

A

Adjacent osteomyelitis
Evidence of bacteremia or febrile illness
Hemarthrosis
Impending joint replacement (days)
Infectious arthritis
Joint prosthesis
Osteochondral fracture
Periarticular cellullitis/severe dermatitis/soft tissue infection
Poorly controlled DM
Uncontrolled bleeding disorder or coagulopathy
Clotting disorder & anticoagulation
Broken skin or cellulitis over injection site
Joint infection
Immunosuppressed patients

21
Q

When to inject with caution?

A 
Charcot joint
Tumor
Neurogenic disease
Active infections
Hypothyroidism
Bleeding dyscrasias
DM
22
Q

Things to Include with Informed Consent

A

Risks
Benefits
Expectations

23
Q

Risks of Injections

A

Infection
Bleeding
Allergic reaction
Pain

24
Q

Benefits of Injection

A

Simple office procedure

25
Q

Expectations from an Injection

A

+/- help or only for a few months
Increased pain for a day or two after injection
May take several days to take effect

26
Q

Why are deep local injections not recommended for anesthesia?

A

May enter joint space

May alter synovial fluid analysis

27
Q

Short Acting Steroid Preparations

A

Hydrocortisone

Prenisolone

28
Q

Long-Acting Steroid Preparations

A 
Kenalog
Aristospan
Depo-Medrol (methylprenisolone)
Decadron
Trimcinolone acetonide
29
Q

Combination Steroid Preparation

A

Celestone Soluspan

30
Q

How do you know when you are in the joint capsule?

A

You will feel a pop

31
Q

Why aspirate the joint prior to injecting?

A

Make sure your not in a vessel

32
Q

Knee Injection Site & Usual Dose

A

S: superolateral
D: 40 mg

33
Q

Types of Shoulder Injections

A

Intra-articular
Subacromial
AC joint

34
Q

Indications for Intra-articular Shoulder Injections

A

Arthritis
Rotator cuff tear
Frozen shoulder

35
Q

Indications for a Subacromial Injection

A

Rotator cuff tendonitis

Bursitis

36
Q

Indications for AC Joint Injection

A

Inflammation

Arthritis

37
Q

What is the most common route of shoulder injections?

A

Posterior with patient sitting

38
Q

How is an anterior shoulder injection performed?

A

Patient in supine position
Below clavicle & lateral to coracoid
Beware of brachial plexus

39
Q

Position of Patient for an AC Joint Injection

A

Sitting

Hands behind back

40
Q

Joint Injection Aftercare

A

PROM
Immediate relief is temporary & may take a couple days for steroid to take effect
Ice/OTC anti-inflammatories
Call: signs of infection/allergic reaction

Ortho (22 decks)

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