JOINT AND SOFT TISSUE INJECTIONS

Aspiration

‡ For diagnosis - gout, blood, (pus) ‡ Therapeutic - relieving pain

Indications for intra articular steroid
‡ Relief of pain resulting from an inflammatory arthritis localised to one or a few joints ‡ Joint synovitis unresponsive to drugs ‡ Capsulitis

Which joints?
‡ ‡ ‡ ‡ ‡ ‡ Knee Shoulder (3 approaches) 1st CMC 1st MTP Radiocarpal Sternoclavicular

Indications for soft tissue injection
‡ Enthesopathies eg tennis elbow, golfers elbow, plantar fasciitis ‡ Compression neuropathies eg carpal tunnel, meralgia parasthetica ‡ Tenosynovitis eg biceps, de Quervains, (trigger finger) ‡ Bursitis eg subacromial, trochanteric

Contraindications
‡ ‡ ‡ ‡ Local infection - septic arthritis, cellulitis Systemic infection - eg TB Psychosis Pregnancy up to 16w

General principles
‡ ‡ ‡ ‡ ‡ ‡ Accurate diagnosis Relaxed patient Mark skin Aseptic (no touch) technique Aspirate first Know the feel

Which steroid?

‡ Hydrocortisone Acetate 25mg/ml ‡ Methylprednisolone acetate 40mg/ml ‡ Triamcinolone hexacetonide 20mg/ml

Local anaesthetic?

‡ Usually lignocaine 1% ‡ Occasionally long acting ‡ Usually mixed

How much?

‡ Half ‡ or one

How often?

‡ No more than 4 weekly intervals ‡ No more than 4 times a year

Post injection advice

‡ Rest 2-3 days ‡ Mobilise

Complications
‡ ‡ ‡ ‡ Steroid flare Infection Skin and fat atrophy tendon rupture (hereditary)

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