Transcript Shoulder and Knee Joint Injectionsx

Shoulder and Knee Joint
Injections
Christopher Gleason, MD
Objectives
• Become familiar with:
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Rationale and indications for joint injections
Contraindications for joint injections
Risks of joint injections
Safety and procedural equipment needed
General procedural technique
Subacromial bursa injection
Inferolateral knee injection
Rationale
• Primary care providers should master the technique of
joint aspiration and injection for several reasons:
• Diagnostic
•Diagnosing an inflamed joint
• Therapeutic
•Pain relief of a distended / painful joint
• Diagnostic
Indications
o To evaluate synovial fluid
• Infections, Rheumatic, Traumatic, or
Crystal-induced etiology
• Therapeutic
o Remove exudate from septic joint
o Relieve pain in grossly swollen joint
o Inject lidocaine, saline, corticosteroids
Indications for injection
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Arthritis – Osteo, Rheumatoid, Gouty, etc
Synovitis – deQuervain’s
Bursitis – Subacromial, Trochanteric, etc
Tendonitis – Epicondylitis, Fasciitis, etc
Neuritis - Carpal Tunnel Syndrome, etc
Fibrositis - Trigger points
Basic Principles
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History and Examination
Conservative Treatment First
Physical Therapy
Appropriate Imaging
Careful Patient Selection
Informed Consent (risks, benefits, options)
Anatomy
Preparation
Absolute
Contraindications
o Sepsis / Local sepsis
o Infection / Cellulitis
o Hypersensitivity
o Early Trauma
o Hemarthrosis
o Prosthetic Joint
o Unstable Joint
o Reluctant Patient
o Children
Relative
Contraindications
•Anticoagulation / Bleeding Disorder
•Diabetic
•Immunosuppressed
•Psychogenic Pain
•Severe Anxiety
•Neuropathic Joint (Charcot)
•Active Infections (Tuberculosis)
•Tumor
•Hypothyroidism
Injection Risks
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Bleeding
Infection / Sepsis
Allergic Reaction – Anaphylaxis, Death
Procedure Failure
Anatomical Damage
Skin Effects – Depigmentation, Necrosis
Pain
•Anesthesia
•Steroid Flare
Medications
Corticosteroids:
• Short acting: Cortisone, Hydrocortisone
• Intermediate acting: Methylprednisone, Triamcinolone
• Long acting: Dexamethasone, Betamethasone
Local Anesthetics:
• Lidocaine: rapid onset, short duration
• Bupivicaine: slow onset, long duration
• Prilocaine: uncommon
Injection Safety
• Aseptic Technique
• Emergency Supplies
o Epinephrine, Bag/Mask, Airway, Oxygen, IV Fluid
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Anaphylaxis / Severe Allergy
Intravascular Injection
Syncope
Universal Precautions
Injection Equipment
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Gloves – Sterile & Non-Sterile
Alcohol / Iodine
Sterile Drape
Gauze / Adhesive Bandage
Appropriate Syringe / Needle
Appropriate Medications
Coolant Spray (optional)
Procedure – Stop / Think
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Patient Considerations / Indications
Contraindications / Risks
Informed Consent
Safety Equipment
Injection Equipment
Medications
Procedure Tray / Injection Ready
Patient / Table Positioning
Procedure - Act
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Identify / Mark Injection Site
Alcohol / Betadine Injection Area
Drape Area as Appropriate
Coolant Spray Prior to Injection
Inject
Monitor Bleeding
Gauze / Adhesive Bandage
Procedure - Review
• Remove / Discard Sharps Appropriately
• Monitor Patient
• Repeat Care & Follow-Up Instructions
• Review Procedural Steps
• Consider Potential Improvement
Subacromial Bursa Injection
Inferior Lateral Knee Injection