Ortho

Question 1

what do you need to ask yourself for joint aspiration?

Answer 1

What are you trying to accomplish (diagnostic/ therapeutic)
Is the area of concern truly intra-articular
What do you do w/ the aspirate?
What do you do with the results?

Question 2

what are various needle sizes

Answer 2

1.5 inches
3 inches for spinal needle
5 inches for extended spinal needle

Question 3

what’s the number one indication to aspirate a joint?

Answer 3

rule out infection
#2- symptomatic relief

Question 4

what is an absolute contraindication for joint aspiration?

Answer 4

overlying cellulitis

Question 5

what do you need to be cautious w/ for joint aspiration?

Answer 5

bleeding issues (current anticoagulation, hemophilia, thrombocytopenia)

Question 6

complications with joint aspiration

Answer 6

infection
hemarthrosis 
syncope
pain
cartilage injury

Question 7

why is it good to get x-rays before aspirating?

Answer 7

R/O fracture
evaluate joint space
evaluate for OA/RA changes
R/O osteomyelitis

Question 8

should you delay aspiration if you have any concern about sepsis

Answer 8

No

Question 9

what joints are easy to aspirate in the clinic?

Answer 9

elbow

knee

Question 10

what joints can’t be aspirated w/o radiographic help

Answer 10

hips

special cases

Question 11

what needle size do you need to aspirate a joint?

Answer 11

18 gauge recommended

no smaller than 20 gauge

Question 12

what do you need to do before aspirating a joint?

Answer 12

Verify allergies
prep area
written/ verbal consent

Question 13

if you are aspirating to evaluate for sepsis can you inject anesthesia/ pain meds/ topicals

Answer 13

No (could contaminate fluid)

Question 14

Procedure for joint aspiration

Answer 14

have some pressure in syringe 
go in right underneath the knee cap 
can add pressure to joint (avoid needle stick)
get as much fluid as you can 
light compression dressing 
follow-up on results

Question 15

What could you hit if you aspirate medially?

Answer 15

Hoffa’s fat pad

Question 16

If you are aspirating a joint what do you need to order STAT?

Answer 16

Gram Stain

cell count

Question 17

if a patient has hemarthrosis w/o trauma what study do you need to get?

Answer 17

coagulation studies

Question 18

what are normal results from a fluid aspiration

Answer 18

colorless
clear clarity
no crystals

Question 19

what will non-inflammatory arthritis look like on aspirate fluid labs

Answer 19

Clear, Yellow, Viscous – 200-2000 Leukocytes (still less than 25% PMN)

Question 20

what will the aspirated fluid come back with for a septic joint

Answer 20

Purulent, 80,000+ Leukocytes (75%+ PMN)

Question 21

what will fluid from a inflammatory arthritis look like on lab results

Answer 21

Cloudy, Yellow, Watery, 2,000-100,000 Leukocytes (25-50% PMN)

Question 22

what do you normally inject into the joint

Answer 22

cortisone (most common)
cortisone/ anesthetic (also common)
viscosupplementation
platelet rich plasma

Question 23

contraindications for joint injection

Answer 23

infection or concern of infection
known allergy/ poor response
history of multiple cortisone injections in same reason

Question 24

what allergy can’t receive viscosupplementation

Answer 24

eggs

Question 25

what are complications of joint injections

Answer 25

infection
soft tissue weakening (multiple)
cartilage damage (marcaine)
skin pigmentation change 
fat atrophy (divet) 
poor response
pain

Question 26

what are common locations for soft tissue injections?

Answer 26

Lateral Epicondylitis - Tennis Elbow (Common Extensor Tendonitis)
Trochanteric Bursitis
Olecranon Bursitis
Pre-patellar Bursitis
Plantar Fascia

Question 27

can you inject a tendon?

Answer 27

No

Question 28

symptoms of tennis elbow? where do you inject?

Answer 28

can’t extend
(lift purse)
inject in lateral epicondyle

Question 29

symptoms of Trochanteric Bursitis

Answer 29

can’t lay on site w/o pain

Question 30

what are Olecranon Bursitis

Answer 30

sepsis
gout
(if non traumatic injury)

Question 31

where is the plantar fascia

Answer 31

medial calcaneal tubercle

Question 32

what injection has some evidence that it is less damaging to tissues

Answer 32

dexamethasone (there is a shortage right now)

Question 33

what are injections for viscosupplementation

Answer 33

Hyalgan (3 or 5 injection series)
Supartz (3 injections series)
Euflexxa (3 injection series / known allergy or history of reaction or pseudo reaction)