Orthopedic Injections Flashcards
1
Q
INDICATIONS FOR INJECTIONS
9
A
- Osteoarthritis
- Rheumatoid arthritis
- Gouty arthritis
- Synovitis
- Bursitis
- Tendonitis
- Muscle trigger points
- Carpal tunnel syndrome
- Wound anesthesia
2
Q
LOCAL INFILTRATION
- Injecting into the subcutaneous tissue of open wounds: does what?
- What do you do before injecting the wound?
- What does epi do?
- Doses for lidocaine and lidocaine with epi?
A
- Injecting into the subcutaneous tissue of open wounds
- Provides good anesthesia
- Little discomfort while injecting - Before injecting, clean and sterilize the wound
- Epinephrine decreases blood loss
- Avoid toxic doses of lidocaine
- 4mg/kg for plain lidocaine
- 7 mg/kg for lidocaine with epinephrine
3
Q
- Field blocks are what?
- Why wouldnt you use locl anethesia for this?
- Skin prep with what?
- Procedure? 2
A
- Good for superficial lesions such as skin abscesses
- Local anesthesia not effective and painful, may spread infection
- Skin preparation with betadine or alcohol
- -Inject slowly
while advancing
needle
-Only need to go
thru skin twice
4
Q
DIGITAL BLOCKS
- Each digit supplied by how many nerves?
- Use what kind of needle?
- Procedure?
- Big toe… may need to make third pass on what?
- Do not use if there is what?
- Be cautious using what?
A
- 4 nerves,
- 2 dorsal
- 2 palmar/plantar - small needle, 25 – 27 gauge
- Start dorsally, go down each side of proximal phalanx
Inject as you go, change angle - dorsal aspect
- vascular compromise
- epinephrine
5
Q
Trigger Point Infections
1. Inflamed tendon/bursa by bony prominence: Use what and when?
- Skin prep with what?
- Slow injection into point of what?
- Advance needle to bone and then withdraw ______?
- Tennis elbow – lateral epicondylitis
- Pain with what? - Greater trochanteric bursitis
- Pain with what? - Ischial tuberosity bursitis – Weaver’s bottom
- Pain with what?
A
- Combination of lidocaine and steroid
- When conservative treatment fails and for Dx
- betadine swab x3 or chloraprep x1 (let dry)
- maximum tenderness
- 2 mm
- resisted wrist dorsiflexion
- stretching of lateral side of hip
- resisted knee flexion
6
Q
Describe the injection for LATERAL EPICONDYLITIS, and GREATER TROCHANTERIC BURSITIS.
4
A
- Find point of maximum tenderness,
- advance needle until it hits bone,
- withdraw needle 2 mm’s
- Patient should confirm that you are in the sore spot
7
Q
ISHCIAL TUBEROSITY BURSITIS Injection 1. What will make the tuberosity more prominent for the maximum tenderness? 2. Key structure to miss?
A
- Feel for point of maximum tenderness, hip flexion makes tuberosity more prominent
- Key structure to miss is the sciatic nerve
Be sure injection site is sterilized
8
Q
AFTERCARE
2
A
- Rest, ice, anti-inflammatories
- Resume conservative treatment including stretching
May be overkill
9
Q
JOINT INJECTIONS
Intra-articular injections with steroids are useful, safe, and cost-effective treatments
1. Most joint injections for symptoms of what?
- Shoulder… also for what? 2
- Which steroids to use?
- Also put needles in joints to aspirate for what?
A
- arthritis
- rotator cuff tendinitis and
- subacromial bursitis
- Methylpredisone is usually first line. depends if you want short or long acting.
- Synovial fluid analysis for arthritis or infection
10
Q
WHY INJECT JOINTS?
- Can be what?
- Inflammation? 3
- Corticosteroid injection helps with what? 3
A
- Can be joint or soft tissue
- Inflammation
- degenerative joint disease,
- bursitis,
- tendinitis - Corticosteroid injection helps
- decrease inflammatory reaction
- includes limiting capillary dilatation
- vascular permeability
11
Q
RISKS OF JOINT INJECTIONS
11
A
- Infections in healthy patients – 1 in 17k to 77K
- Soft tissue infection - 1 in 10K
- Acceleration of a septic joint
- SubQ atrophy and skin depigmentation in
12
Q
CONTRAINDICATIONS for joint injections
15
A
- Adjacent osteomyelitis
- Evidence of bacteremia or febrile illness
- Hemarthrosis
- Impending (scheduled within days) joint replacement surgery
- 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
13
Q
INJECT WITH CAUTION
7
A
- Charcot joint (neuropathic sensory loss)
- Tumour
- Neurogenic disease
- Active infections (eg, tuberculosis)
- Hypothyroidism
- Bleeding dyscrasias
- Diabetics (likely to raise BG for several days)
14
Q
EQUIPMENT
for injections 10
A
- Sterile gloves and drapes
- 5 Gauze pads (4x4)
- Skin prep solution
- Lidocaine 1%
- Steroid of choice
- Syringes….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
15
Q
INFORMED CONSENT: Tell them about?
- Risks? 4
- Benefits? 2
- Realistic expectations? 3
A
- Risks:
- infection,
- bleeding,
- allergic reaction,
- pain - Benefits:
- simple office procedure
- May provide relief for patients too frail for definitive treatment - Realistic expectations
- May not help or only for a few months
- May have increased pain for a day or two after the injection
- May take several days to take effect