Ortho Flashcards
what do you need to ask yourself for joint aspiration?
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?
what are various needle sizes
1.5 inches
3 inches for spinal needle
5 inches for extended spinal needle
what’s the number one indication to aspirate a joint?
rule out infection #2- symptomatic relief
what is an absolute contraindication for joint aspiration?
overlying cellulitis
what do you need to be cautious w/ for joint aspiration?
bleeding issues (current anticoagulation, hemophilia, thrombocytopenia)
complications with joint aspiration
infection hemarthrosis syncope pain cartilage injury
why is it good to get x-rays before aspirating?
R/O fracture
evaluate joint space
evaluate for OA/RA changes
R/O osteomyelitis
should you delay aspiration if you have any concern about sepsis
No
what joints are easy to aspirate in the clinic?
elbow
knee
what joints can’t be aspirated w/o radiographic help
hips
special cases
what needle size do you need to aspirate a joint?
18 gauge recommended
no smaller than 20 gauge
what do you need to do before aspirating a joint?
Verify allergies
prep area
written/ verbal consent
if you are aspirating to evaluate for sepsis can you inject anesthesia/ pain meds/ topicals
No (could contaminate fluid)
Procedure for joint aspiration
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
What could you hit if you aspirate medially?
Hoffa’s fat pad
If you are aspirating a joint what do you need to order STAT?
Gram Stain
cell count
if a patient has hemarthrosis w/o trauma what study do you need to get?
coagulation studies
what are normal results from a fluid aspiration
colorless
clear clarity
no crystals
what will non-inflammatory arthritis look like on aspirate fluid labs
Clear, Yellow, Viscous – 200-2000 Leukocytes (still less than 25% PMN)
what will the aspirated fluid come back with for a septic joint
Purulent, 80,000+ Leukocytes (75%+ PMN)
what will fluid from a inflammatory arthritis look like on lab results
Cloudy, Yellow, Watery, 2,000-100,000 Leukocytes (25-50% PMN)
what do you normally inject into the joint
cortisone (most common)
cortisone/ anesthetic (also common)
viscosupplementation
platelet rich plasma
contraindications for joint injection
infection or concern of infection
known allergy/ poor response
history of multiple cortisone injections in same reason
what allergy can’t receive viscosupplementation
eggs
what are complications of joint injections
infection soft tissue weakening (multiple) cartilage damage (marcaine) skin pigmentation change fat atrophy (divet) poor response pain
what are common locations for soft tissue injections?
Lateral Epicondylitis - Tennis Elbow (Common Extensor Tendonitis) Trochanteric Bursitis Olecranon Bursitis Pre-patellar Bursitis Plantar Fascia
can you inject a tendon?
No
symptoms of tennis elbow? where do you inject?
can’t extend
(lift purse)
inject in lateral epicondyle
symptoms of Trochanteric Bursitis
can’t lay on site w/o pain
what are Olecranon Bursitis
sepsis
gout
(if non traumatic injury)
where is the plantar fascia
medial calcaneal tubercle
what injection has some evidence that it is less damaging to tissues
dexamethasone (there is a shortage right now)
what are injections for viscosupplementation
Hyalgan (3 or 5 injection series)
Supartz (3 injections series)
Euflexxa (3 injection series / known allergy or history of reaction or pseudo reaction)
