wk 4- applications of LA and techniques Flashcards
prolotherapy
tissue injection of a substance (irritant) that helps with healing by kickstarting the bodies natural healing system
-glucose
-dextose
what can injection therapy do
-pain relief (longer lasting LA, injury, trauma)
-procedural (surgeries)
-diagnostic (injecting into structures to assess pain)
-therapeutic (stimulate healing: more blood flow, motion and reduced inflammation)
choice of anaesthetic depends on
-duration required
-safety profile
-off label v on label use- off label if youve trained in Uk or elsewhere
-complicating factors like pH change
-evidence
-personal choice
clinical uses of LA
heel pain
nerve entrapment
scar adhesiotomy
complex regional pain syndrome
joint pain
lignocaine is
fast onset, mod duration
prilocaine is
fast onset, moderate duration
bupivicaine
slow onset, long duration
ropivocaine
sow onset, long duration
lidocaine and bupivicaine are commonly used for
nail surgeries
lidocaine when its a quicker surgery
bupivocaine when more toes are required
cortisone is good for what chronic pain syndromes
OA
RA
impingement
tendinitis/fascitis
bursitis
neuritis
types of injection therapies
LA
steroid
glucose
PRP
stem
what does a cortisone do
strong anti inflammatory agent
inhibits fibroblast activity- slows down development of thickening of fascia
ladder of intervention
physical
inject
operate
when should cortisone be used
inflammation when conditions (itis) are occuring before they get to chronic conditions (opathy)
how do you inject cortisone
around the tendons/structures, not within
unless wanting to rupture for a different rehabiliation (surgery)
complications of cortisone
-interferes with prostaglandin production
-skin/fat catabolism
-steroid flare
-tissue atrophy
-tendon/joint damage
-infection
-skin hypo/hyperpigmentation
what is prolotherapy
regenerative injection therapy
injections to stimulate irritation which causes repair through the healing process
saline
glucose
dextrose
adverse effects of injections
bruising
swelling
stiffness
infection
transient worsening of symptoms
solution interactions (lidocaine and joints, steroid and hypergylcameia)
what is regional nerve block
block pain from a large area of the body
types of regional nerve blocks
- epidural (around spinal)
- spinal (intrathecal)
- perineural (beside or around nerve- infiltration)
4.nerve block (injection proximal to site of pain)
ankle block is how many injections
5- sural 3-5ml, tibial 5ml, superficial perioneal 3-5ml, deep peroneal 3-5ml, saphenous 3ml
not a motor block
mayo block
combination of nerve block an infiltration in a ring shape around 1st MTPJ (3-4injections)
good for toe/bunion surgery
plantar infilitration indications
good for
verruca,
neurovasuclar corns,
foregin bodies
inject in a clock motion without taking the needle out
neuroma potential injections
- pain relief (anti inflammatory/break down fibrotic tissue when combined with cortisone)
- hydrodilation (break down scar tissue with the use of saline combined)- up to 3 injections
- diagnostic (lA by itself to know it its nerve)
