Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ORTHO > ORTHO INJECTIONS > Flashcards

ORTHO INJECTIONS Flashcards

1
Q

INDICATIONS FOR INJECTIONS

A 
⦁	Wound Anesthesia
⦁	Osteoarthritis 
⦁	Rheumatoid arthritis
⦁	Gouty arthritis
⦁	Synovitis
⦁	Bursitis
⦁	Tendonitis 
⦁	Muscle trigger points 
⦁	Carpal tunnel syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q
  • injecting into subcutaneous tissue of open wounds
A

local infiltration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

LOCAL INFILTRATION

A
  • injecting into subcutaneous tissue of open wounds
  • clean & sterilize wound
  • avoid toxic doses of lidocaine
    ⦁ 4 mg/kg for plain lidocaine
    ⦁ 7 mg/kg for lido + epi
  • epi = decreases blood loss / controls bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

max doses of lidocaine

A

⦁ 4 mg/kg for plain lidocaine (jen says 4.5)

⦁ 7 mg/kg for lido + epi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

FIELD BLOCKS

A
  • good for superficial lesions, such as skin abscesses

⦁ local anesthesia is not effective and is painful. May spread the infection

  • prep skin with betadine or chlorohexidine
  • inject slowly while advancing the needle, only go thru the skin twice
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

DIGITAL BLOCKS

A
  • use 25-27 gauge needle
  • each digit is supplied by 4 nerves: 2 dorsal, 2 palmar / plantar
  • start dorsally, inject straight down each side of proximal phalanx

⦁ inject as you go - change angle
⦁ Big toe - may need to make a 3rd pass on the dorsal aspect

  • Do not use if there is vascular compromise
    ⦁ be cautious using EPI HERE**
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

STEROID INJECTIONS

A
  • for inflamed tendon / bursa by a bony prominence (ex: subacromial bursitis - tendonitis)
  • inject combo: Lidocaine + Steroid
  • indicated for when conservative treatment fails and for diagnosis

Prep skin with betadine swab (3x) or chloroprep (1x) - let dry

  • slowly inject into point of maximum tenderness
  • advance the needle to bone, then withdraw 2mm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

common areas for injections

A
  • Tennis elbow = lateral epicondylitis (pain with resisted wrist dorsiflexion = extension)
  • Greater trochanteric bursitis - pain with stretching of lateral side of hip
    ⦁ Ober’s test
    ⦁ may need spinal need if bigger pt
  • Ischial tuberosity bursitis = Weaver’s bottom - pain with resisted knee flexion
    ⦁ be careful of sciatic nerve
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Ober’s test

A

to identify tightness of the iliotibial band (iliotibial band syndrome)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

AFTERCARE FOR TENDONITIS / BURSITIS INJECTIONS

A
  • Rest, Ice, Anti-inflammatories

- Resume conservative treatment, including stretching

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

TRIGGER POINT INJECTIONS

A 
⦁	Smaller volume
⦁	Inject into areas of tenderness
⦁	Mostly located into upper neck and mid back areas
⦁	Usually just use Lidocaine 
⦁	Small needle, and gauge depth.
⦁	Remember skin atrophy and blanching
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

trigger points are most commonly located

A

in upper neck and mid back areas

sensitive areas in the muscle or connective tissue (fascia) that becomes painful when compressed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

JOINT INJECTIONS

A
  • intra-articular injections with steroids are useful, safe, and cost-effective treatments
  • most joint injections are for symptoms of arthritis

⦁ shoulder - also for rotator cuff tendonitis & subacromial bursitis

  • for knee, shoulder, AC joint - must know your anatomy
  • can also put needles into joints to aspirate (remove synovial fluid - analysis for arthritis or infection)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

most joint injections are for symptoms of

A

arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

WHY INJECT JOINTS

A
  • can be joint or soft tissue issue
  • inflammation
    ⦁ could be from degenerative joint disease, bursitis, and tendonitis
  • corticosteroid injections help decrease inflammatory reaction - limits capillary dilatation & vascular permeability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

BASIC PRINCIPLES TO JOINT INJECTIONS

A
  • HX & PE
  • try conservative treatment first - NSAIDS, RICE, etc. - continue these treatments after joint injection
  • careful patient selection
  • informed consent - get signature
  • know your anatomy!
  • undertake as few injections as possible to settle the problem: q3-4 months
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

RISKS OF JOINT INJECTIONS

A

⦁ infections
⦁ soft tissue infection
⦁ acceleration of a septic joint (missed septic joint)

⦁ SubQ atrophy & skin depigmentation - where steroid was injected subcutaneously

⦁ steroid flare: facial flushing in first 24-48 hrs

- clears in 1-2 days
- not an allergic reaction!!!

⦁ Exacerbation of diabetes*** - warn patients to monitor their blood sugars (spikes)

⦁ Cartilage damage - happens with repeated serial injections

⦁ Tendon rupture - only if injecting around the tendon

⦁ Allergic reaction
⦁ Anaphylactic reaction - within 5-10 minutes of the injection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

CONTRAINDICATIONS TO JOINT INJECTIONS

A

⦁ Adjacent osteomyelitis
⦁ Evidence of bacteremia or febrile illness
⦁ Hemarthrosis
⦁ Impending joint replacement surgery (scheduled within days)
⦁ Infectious arthritis
⦁ Joint prosthesis
⦁ Osteochondral fracture
⦁ Periarticular cellulitis / severe dermatitis/ soft tissue infection
⦁ Poorly controlled diabetes mellitus
⦁ Uncontrolled bleeding disorder or coagulopathy
⦁ Clotting disorder and anticoagulation(correct before injecting)
- Probably okay if INR < 1.8
⦁ Broken skin or cellulitis over injection site
⦁ Joint infection
⦁ Allergy to local anesthetic or steroid preservative
⦁ Immunosuppressed (by drugs or disease)

19
Q

INJECT WITH CAUTION IN THE FOLLOWING PATIENTS

A

o Charcot joint (neuropathic sensory loss)
o Tumor
o Neurogenic disease
o Active infections (ex: TB)
o Hypothyroidism
o Blood dyscrasias
o Diabetics (likely to raise BG levels for several days)

20
Q

EQUIPMENT NEEDED FOR INJECTONS

A 
Sterile gloves and drapes
Retractable ball point pen
Alcohol wipes
5 Gauze pads (4x4)
Skin prep solution
Lidocaine 1%
Steroid of choice
Syringes….3ml,5ml, 20 ml, 30 ml, 60 ml
Needles….18 or 20 G and 25 or 27 G
            - Morbidly obese patients may require a 21 G    spinal needle for arthrocentesis

Hemostat
Specimen tubes
Bandage

21
Q

INFORMED CONSENT - PATIENT EDUCATION

A 
- Risks 
⦁	infection
⦁	bleeding
⦁	allergic reaction
⦁	pain
  • Benefits
    ⦁ simple office procedure
    ⦁ may provide relief for patients that are too frail for definitive treatment
  • Realistic Expectations
    ⦁ may not help or may only help for limited amount of time
    ⦁ may have increased pain for 1-2 days after injection
    ⦁ may take several days to take effect
22
Q

ANESTHESIA PRIOR TO JOINT INJECTION

A
  • often warranted - good idea!
  • after skin prep / draping / identification of needle insertion site, use 25-27 gauge needle to inject 2-5 mL of local anesthetic into subcutaneous tissue

⦁ OK if you enter joint space; will have minimal effect to alter synovial fluid analysis results

⦁ Biggest concern = introducing bacteria while injecting anesthetic

23
Q

biggest concern of anesthetic injection prior to steroid + lido injection

A

introducing bacteria while injecting anesthetic

24
Q

STEROIDS FOR INJECTIONS

A
  • some take effect faster, others take and therefore last longer
  • short acting preparations (soluble)
    ⦁ Hydrocortisone
    ⦁ Prednisolone
  • long acting preparations (depot steroids)
    ⦁ Kenalog (triamcinolone acetonide): 40mg / large, 30mg / medium, 10mg / small
    ⦁ Depo-Medrol (methylprednisolone)
    ⦁ Decadron (dexamethasone)
  • Combination preparations (soluble + depot)
    ⦁ Celestone Soluspan
  • Half life of intra-articular injections - can give months of relief
    ⦁ Depo Medrol = 6 days
    ⦁ Kenalog = 22 days
25
Q

soluble (short-acting) steroids

A

⦁ Hydrocortisone

⦁ Prednisolone

26
Q

depot steroids (long-acting preparations)

A

⦁ Kenalog (triamcinolone acetonide): 40mg / large, 30mg / medium, 10mg / small
⦁ Depo-Medrol (methylprednisolone)
⦁ Decadron (dexamethasone)

27
Q

combination steroid

A

soluble + depot preparation

⦁ Celestone Soluspan

28
Q

INJECTION TECHNIQUE

A
  • swab top of vials with alcohol before drawing into syringe - let dry first!!!!!!
  • change needles after drawing up solution in the syringe
  • visualize anatomy
  • mark area for the injection with marker or pen
  • need sterile gloves only if you need to feel the site after prep
  • prep area with betadine swabs or chlorohexadine or alcohol
  • choose needle & syringe based on joint involved
  • advance needle slowly until you feel a pop —through capsule
  • once needle is felt to be in the joint, aspirate before injecting
  • grasp needle with hemostat while you twist off the syringe and swap syringes while leaving needle in
  • put aspirated fluid in collection tube
  • if you meet resistance while injecting = probably not in the joint! - back up a bit
    ⦁ the amount of resistance felt depends on the diameter of the needle
29
Q

ASPIRATION TECHNIQUE

A
  • for suspected septic joint or for painful hemarthrosis
    ⦁ Use same route as for injection
    ⦁ Larger needle so fluid can be withdrawn (effusion and hemarthrosis)
    ⦁ Large syringe to withdraw fluid
    ⦁ Anesthetize track down to the joint
    ⦁ Same skin prep as for injections

so use same needle to aspirate into syringe, then swab out with hemostat to anesthetize. then switch to different needle/syringe to inject steroid + lido

30
Q

KNEE INJECTIONS FOR OSTEOARTHRITIC PAIN

A

⦁ Best approach to a knee injection is the path of least obstruction and maximal access to the synovial cavity….which could be superolateral, superomedial or anteromedial/anterolateral

⦁ Plain radiographs recommended for assessment of the bony anatomy of the individual knee joint

⦁ The knee injection site can be selected according to the patient’s bony anatomy and marked with the tip of a retracted ball point pen before sterile prep

⦁ 3-5 ml 1% Lidocaine and 20-80 mg
methylprednisolone/or 40mg of Kenalog.

31
Q

best approach to knee injection - to have maximal access to synovial cavity

A

SUPEROLATERAL
superomedial
or anteromedial/anterolateral

32
Q

KNEE INJECTIONS

A
  • common & relatively easy - as it is a large joint and there are good landmarks
  • knee joint = one of the most common joints for PCP to aspirate & inject
  • Superolateral Approach = lateral side at level of superior pole of patella

⦁ Anterior medial approach = can end up injecting into the fat pad rather than the joint

33
Q

best injection site for knee injection

A

superolateral

34
Q

which knee injection site can you end up injecting into the fat pad rather than the joint

A

anteromedial

35
Q

KNEE INJECTION PROCEDURE - superolateral approach

A
  • Position slightly flexed knee with a towel in the popliteal space on exam table
  • Superolateral approach
    ⦁ Clinician’s thumb is used to gently rock then stabilize the patella
    ⦁ Palpate the superior lateral aspect of the patella and insert the needle 1 cm superior and lateral to the this point
    ⦁ Apply gentle pressure on the contralateral side of the knee to encourage the fluid to pool in the area of aspiration.
    ⦁ Direct the needle under the patella at a 45 degree angle to the midpoint area
    ⦁ Aspirate all fluid prior to injection
    ⦁ There should be no resistance!
36
Q

KNEE INJECTION PROCEDURE - anterolateral / medial approach

A
  • Anterolateral / mediolateral approach
    ⦁ Facing patient with knee hanging over the end of the table
    ⦁ Palpate the inferior pole of the patella, and move medial or lateral depending on which side you want.
    ⦁ You will feel for the edge of the patellar tendon and will fall into a “soft spot”. This is your area of injection.
    ⦁ Make a mark with thumbnail or pen. Clean area with betadine or scrub of choice.
    ⦁ Insert needle at marked point angling towards center of knee on a horizontal.
    ⦁ Feel needle enter joint and inject slowly. Should inject easily.
    ⦁ Remove and place band aid.
37
Q

SHOULDER INJECTIONS

A

INDICATIONS

o intra-articular
⦁ arthritis
⦁ rotator cuff tear
⦁ frozen shoulder

o Subacromial
⦁ rotator cuff tendonitis
⦁ bursitis

o AC joint
⦁ inflammation / arthritis

38
Q

most common shoulder injection location

A

posterior shoulder

39
Q

POSTERIOR SHOULDER INJECTIONS

A

= most common route

  • patient sitting
  • inject 2 cm blow the base of the acromion, and 2 cm medial to the edge of the humerus
  • can feel the joint move in the slender angle towards the tip of the coracoid process
40
Q

ANTERIOR SHOULDER INJECTION

A
  • not used as much
  • patient supine
  • fingertip below the clavicle and lateral to the tip of coracoid process
    ⦁ inject into the upper half of the joint; avoid brachial plexus
  • can usually feel the joint move!
41
Q

how should the patient sit for AC joint injection

A

sitting with hands behind back - makes joint more prominent and easier to palpate

42
Q

AC JOINT INJECTION

A
  • patient sitting with hands behind back = makes the joints more prominent and easier to palpate
  • palpate the joint - inject from above and angle medially
43
Q

JOINT INJECTION AFTER-CARE

A

⦁ Passive ROM after injection
⦁ Explain that immediate effect is due to local anesthetic, steroid may take several days to show benefit and they may have a flare up of pain before seeing benefit from steroid
⦁ OK to use ice/OTC anti-inflammatories – do not use hot pad
⦁ Call if signs of infection/allergic reactions

ORTHO (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions