Injections Flashcards
Indications for Injections
Osteoarthritis Rheumatoid arthritis Gouty Arthritis Synovitis Bursitis Tendonitis Muscle trigger points Carpal tunnel syndrome Wound anesthesia
Describe Local Infiltration
Injecting into the subcutaneous tissue of open wounds
How to clean & sterilize the wound?
Clean it enough
Perform injection
Scrub the skin
What medication decreases blood loss?
Epinephrine
Describe a Field Block
Inject a diamond around the wound
How does one perform a field block?
Skin prep
Inject slowly while advancing the needle
Pull needle almost out and switch directions
Repeat on other side
How to Perform a Digital Block
Start dorsally
Go down proximal phalynx
Caution with Digital Blocks
Use of epinephrine
Indication for Trigger Point Injections
Inflamed tendon or bursa by a bony prominence
What ortho issue has pain with resisted wrist dorsiflexion?
Tennis elbow
Lateral epicondylitis
What ortho issue has pain with stretching of the lateral side of hip?
Greater trochanteric bursitis
What is ischial tuberosity bursitis due to?
Prolonged sitting
What ortho issue has pain with resisted flexion?
Ischial tuberosity bursitis
Aftercare for an Injection
Rest
Ice
Anti-inflammatories
Resume conservative stretching
Why inject joints?
Inflammation
Inflammatory Conditions that Benefit from Injections
DJD
Bursitis
Tendonitis
How does corticosteroid injections help decrease inflammatory reactions?
Limit capillary dilatation
Vascular permeability
Risks of Joint Injections
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
Describe a Steroid Flare
Facial flushing
First 24-48 hours
Clears in 1-2 days
Contraindications for Injections
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
When to inject with caution?
Charcot joint Tumor Neurogenic disease Active infections Hypothyroidism Bleeding dyscrasias DM
Things to Include with Informed Consent
Risks
Benefits
Expectations
Risks of Injections
Infection
Bleeding
Allergic reaction
Pain
Benefits of Injection
Simple office procedure
Expectations from an Injection
+/- help or only for a few months
Increased pain for a day or two after injection
May take several days to take effect
Why are deep local injections not recommended for anesthesia?
May enter joint space
May alter synovial fluid analysis
Short Acting Steroid Preparations
Hydrocortisone
Prenisolone
Long-Acting Steroid Preparations
Kenalog Aristospan Depo-Medrol (methylprenisolone) Decadron Trimcinolone acetonide
Combination Steroid Preparation
Celestone Soluspan
How do you know when you are in the joint capsule?
You will feel a pop
Why aspirate the joint prior to injecting?
Make sure your not in a vessel
Knee Injection Site & Usual Dose
S: superolateral
D: 40 mg
Types of Shoulder Injections
Intra-articular
Subacromial
AC joint
Indications for Intra-articular Shoulder Injections
Arthritis
Rotator cuff tear
Frozen shoulder
Indications for a Subacromial Injection
Rotator cuff tendonitis
Bursitis
Indications for AC Joint Injection
Inflammation
Arthritis
What is the most common route of shoulder injections?
Posterior with patient sitting
How is an anterior shoulder injection performed?
Patient in supine position
Below clavicle & lateral to coracoid
Beware of brachial plexus
Position of Patient for an AC Joint Injection
Sitting
Hands behind back
Joint Injection Aftercare
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
