Joint Injection For Lab Flashcards
What is the purpose of joint injections?
Provide pain relief at site of inflammation while avoiding side effects of systemic steroids
What is the function of joint injections?
Works to suppress synovial inflammation
Indications for joint injection
Severe OA
RA
Gout
Psoriatic arthritis
Spondyloarthropathy
Subdeltoid bursitis or rotator cuff tendonitis
Indications for joint aspiration
Large hemarthrosis
Synovial fluid assessment
Contraindications to joint injection
Tendón rupture or risk of tendon rupture
Periarticular fracture
Periarticular osteoporosis
Joint instability
Infection: cellulitis, Periarticular osteomyelitis, septic arthritis
Prosthetic joint components
Caution for steroid use
DM
HTN
Osteoporosis
Awaiting joint replacement
Complications of joint injection
Generally low risk
Post injection joint pain
Iatrogenic infection
Soft tissue injury
How frequently can joint injections be performed?
Approx every 3 months varying depending on joint injected
No more than 3-4 per joint per year
Most commonly used agents for joint injection
Methylprednisolone 40-80 mg, comes in 40 mg/mL and 80 mg/mL
Triamcinolone 20-40 mg, comes in 10 mg/mL and 40 mg/mL
What can you use to anesthetize the SQ tissue for injection?
Local anesthetic: 2-5 mL total with 25 or 27 gauge 1 inch needle, avoiding deep injection
May also use topical ethyl chloride spray
Plain lidocaine 1% or 2% in a 1:1 ratio mixed with steroid: immediate onset, lasts 2-4 hours
Shoulder and knee can take up to 10 mL of solution
What needle and syringe should be used for corticosteroid injection?
25-27 g needle
5 mL syringe
1 1/2 inch needle
What needle and syringe should be used for aspiration
18-20 g needle
5-20 mL syringe depending on size and location of effusion
1 1/2 inch needle
Cleansing products for skin preparation
Alcohol
Iodine
Chlorhexidine
Post injection care
Apply ice to joint that evening
No strenuous activity x 48hours
Advise on signs of infection and when to return to clinic
