Splinting/Joint Injection Lab Flashcards
What is the purpose of injecting a steroid?
Pain relief at the site with minimal systemic effects via suppression of synovial inflammation
Primary 4 indications for injections
- Severe OA
- RA
- Inflammatory dz: Gout, Psoriatic arthritis, spondyloarthropathy
- Subdeltoid bursa or rotator cuff tendonitis
Main 2 indications for aspiration
- Large hemarthrosis
- Synovial fluid analysis
When is joint injection CONTRAINDICATED?
- Tendon rupture/risk of
- Periarticular fx
- Periarticular osteoporosis
- Joint instability
- Infection (cellulitis, periarticular osteomyelitis, septic arthritis)
- Prosthetic joint components
AKA if the site is pretty risky
In what kind of conditions should we be wary of using steroids for joint injection?
- DM
- HTN
- Osteoporosis
- Joint replacement
What must you obtain prior to joint injection!
Informed consent
What are the usual complications of joint injections?
- Postinjection pain
- Iatrogenic infection :(
- Soft tissue injury
How many steroids injections annually?
3-4 max per joint per year
Therefore around every 3 months on average.
Two top steroids for injection
- Methylprednisolone (Depo-Medrol) 40-80 mg/mL
- Triamcinolone (Kenalog) 20-40 mg/mL
How do we anesthetize the SQ tissue?
- 25-27G 1 inch needle with 2-5 mL of bupivacaine/lido
- Topical ethyl chloride spray
- Mixing lido with steroid
Shoulder and knee may take up to 10 mL of solution
Choice of needle size for steroid injection?
- 25-27G
- 5 mL syringe
- 1.5 inch needle
Choice of needle for aspiration?
- 18-20G needle
- 5-20 mL syringe
- 1.5 inch needle
Need a bigger needle since we are drawing synovial fluid up!
What do we prep skin with prior to injection?
- Alcohol
- Iodine
- Chlorhexidine
Sterile technique
Pt education after joint injection
- Ice it
- No strenuous activity x 48h
- Advise on signs of infection and return precautions
4 approaches for knee injections
- Lateral retropatellar
- Medial retropatellar
- Anterior
- Suprapatellar (for suprapatellar effusions)
Where is the lateral access point?
Junction of upper and middle third of patella
Apply pressure medially and poke in the groove.
How do you aim the needle for the lateral retropatellar approach?
Slightly medially and inferiorly
Where are shoulder injections performed?
Glenohumeral joint
Once your needle is in, what’s the first thing you do?
Aspirate to check for blood.
