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

choice of anaesthetic depends on

Answer 3

-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

Question 4

clinical uses of LA

Answer 4

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

Question 5

lignocaine is

Answer 5

fast onset, mod duration

Question 6

prilocaine is

Answer 6

fast onset, moderate duration

Question 7

bupivicaine

Answer 7

slow onset, long duration

Question 8

ropivocaine

Answer 8

sow onset, long duration

Question 9

lidocaine and bupivicaine are commonly used for

Answer 9

nail surgeries

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

Question 10

cortisone is good for what chronic pain syndromes

Answer 10

OA
RA
impingement
tendinitis/fascitis
bursitis
neuritis

Question 11

types of injection therapies

Answer 11

LA
steroid
glucose
PRP
stem

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

ladder of intervention

Answer 13

physical
inject
operate

Question 14

when should cortisone be used

Answer 14

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

Question 15

how do you inject cortisone

Answer 15

around the tendons/structures, not within

unless wanting to rupture for a different rehabiliation (surgery)

Question 16

complications of cortisone

Answer 16

-interferes with prostaglandin production

-skin/fat catabolism

-steroid flare

-tissue atrophy

-tendon/joint damage

-infection

-skin hypo/hyperpigmentation

Question 17

what is prolotherapy

Answer 17

regenerative injection therapy

injections to stimulate irritation which causes repair through the healing process

saline
glucose
dextrose

Question 18

adverse effects of injections

Answer 18

bruising
swelling
stiffness
infection
transient worsening of symptoms
solution interactions (lidocaine and joints, steroid and hypergylcameia)

Question 19

what is regional nerve block

Answer 19

block pain from a large area of the body

Question 20

types of regional nerve blocks

Answer 20

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

Question 21

ankle block is how many injections

Answer 21

5- sural 3-5ml, tibial 5ml, superficial perioneal 3-5ml, deep peroneal 3-5ml, saphenous 3ml

not a motor block

Question 22

mayo block

Answer 22

combination of nerve block an infiltration in a ring shape around 1st MTPJ (3-4injections)

good for toe/bunion surgery

Question 23

plantar infilitration indications

Answer 23

good for
verruca,
neurovasuclar corns,
foregin bodies

inject in a clock motion without taking the needle out

Question 24

neuroma potential injections

Answer 24

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)- up to 3 injections
3. diagnostic (lA by itself to know it its nerve)

Question 25

how to perform hydrodilate (LA only) in neuroma

Answer 25

3 injections, 2 weeks apart

Question 26

how do u inject a neuroma

Answer 26

dorsal aspect of foot , distal to the met heads

Question 27

heel pain potential injection options

Answer 27

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