wk 4- applications of LA and techniques

Question 1

prolotherapy

Answer 1

tissue injection of a substance (irritant) that helps with healing by kickstarting the bodies natural healing system

-glucose
-dextose

Question 2

what can injection therapy do

Answer 2

-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)

Question 3

how to overcome barriers that limit our confidence in using injectables

Answer 3

workshops
peer support
case discussion
literature review
endorsement
do the procedures

Question 4

choice of anaesthetic depends on

Answer 4

-duration required
-safety profile
-off label v on label use- off label if youve trained in Uk or elsewhere
-complicating factors like pH change

Question 5

clinical uses of LA

Answer 5

heel pain
nerve entrapment
scar adhesiotomy
complex regional pain syndrome
joint pain

Question 6

lignocaine is

Answer 6

fast onset, mod duration

Question 7

prilocaine is

Answer 7

fast onset, moderate duration

Question 8

bupivicaine

Answer 8

slow onset, long duration

Question 9

ropivocaine

Answer 9

sow onset, long duration

Question 10

lidocaine and bupivicaine are commonly used for

Answer 10

nail surgeries

lidocaine when its a quicker surgery
bupivocaine when more toes are required

Question 11

cortisone is good for what conditions

Answer 11

chronic pain syndromes like:
OA
RA
impingement
tendinitis/fascitis
bursitis
neuritis

Question 12

what does a cortisone do

Answer 12

strong anti inflammatory agent

inhibits fibroblast activity- slows down development of thickening of fascia

Question 13

when should cortisone be used

Answer 13

inflammation when conditions (itis) are occuring before they get to chronic conditions (opathy)

Question 14

how do you inject cortisone

Answer 14

around the tendons/structures, not within

unless wanting to rupture for a different rehabiliation (surgery)

Question 15

considerations of cortisone

Answer 15

-interferes with prostaglandin production

-skin/fat catabolism

-steroid flare

-tissue atrophy

-tendon/joint damage

-infection

-skin hypo/hyperpigmentation

Question 16

what is prolotherapy

Answer 16

regenerative injection therapy

injections to stimulate repair of the healing process

saline
glucose
dextrose

Question 17

adverse effects of injections

Answer 17

bruising
swelling
stiffness
infection
transient worsening of symptoms
solution problems

Question 18

what is regional nerve block

Answer 18

block pain from a large area of the body

Question 19

types of regional nerve blocks

Answer 19

1. epidural (around spinal)
2. spinal (intrathecal)
3. perineural (beside or around nerve- infiltration)
   4.nerve block (injection proximal to site of pain)

Question 20

ankle block is how many injections

Answer 20

5- sural, post tib, superficial, deep peroneal, saphenous

not a motor block

Question 21

mayo block

Answer 21

ring shape injection around 1st MTPJ (3-4injections)

good for toe/bunion surgery

Question 22

plantar infilitration

Answer 22

good for verruca, neurovasuclar corns, foregin bodies

inject in a clock motion without taking the needle out

Question 23

neuroma potential injections

Answer 23

1. pain relief (anti inflammatory/break down fibrotic tissue when combined with cortisone)
2. hydrodilation (break down scar tissue with the use of saline combined)
3. diagnostic (lA by itself to know it its nerve)

Question 24

how to perform hydrodilate (LA only) in neuroma

Answer 24

3 injections, 2 weeks apart

Question 25

how do u inject a neuroma

Answer 25

dorsal aspect of foot , distal to the met heads

Question 26

heel pain potential injection options

Answer 26

1. anti inflammation/ mobility (LA cortisone)
2. pain relief (LA)
3. diagnostic (LA injected to assess if symptoms are reduced)