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DIPROFOS'
'l ml contains:
2 mg of betamethasone in the form of the phosphate
+ 5 mg of betamethasone in the form of the dipropionate

7 mgof betamethasone

EQUIVALENCE
OF SYSTEMIC CORTICOSTEROI DS
(from

GOOD|/AN & GIIMAN'S ' EIGHTH EDITION -CHP. 60,31

FA/.s /f*/r"f /sn/r{/f


5mg

25 mg

4mg

4mg

2rg

53 m9

13 mg

66,5 mg

10,5 mg

10,5 mg

5rg

2rg

2mg

80 mg

20mg

100 mg

16 mg

8rg

3mg

3mg

133 mg

33

13 rng

5rg

5rg

160 mg

l6

6mg

619

186,5 mg

18,5 mg

7ng

7^g

20

mg

200 mg

ANII

DURAIION' OT ACTION
's
I

(biolosicol hol{'lile ol s to I 2 hours)


= sHoRT

ll..'ltRrrlEDlAlt lbioloskol hollli{e ol I 2

36

| = LO|IG lbiolosiol holl-lile of 36 b 72 hounl

ho,ll)

mg

mg

0,75 mg

166,5 mg

26,5 mg

26,5 mg

40 mg

200 mg

32 mg

32 mg

46,5 mg

233 mg

37 mg

37

250 mg

40

40 mg

20 mg

7,5 ng

7,5 nW

50

mg

mg

mg

ng

ntg

tl

0,8

t0

25

25

0,8

0,8

0,5

INTIAMMATORY ACIION

SOUUM REIENTION

l6

0,75

INJECTIONS AND INFILTRATIONS OF THE KNEE

INJECTIONS AND INFILTRATIONS OF THE SHOULDER

TNJECTIONS

I
i

AND INFILTRATIONS OF THE ELBOW

TNJECTIoNS AND INFILTRATIoNS

oF THE HAND

INJECTIONS
AND INFITTR/NTIONS
OF THE KNEEAfthough a painful and pxsibly swollen knee will readily evoke a diagnosis of inflammatory infective, or degenerative joint disease, it should be remembered that the knee is a common site of abafticular or soft tissue rheumatic dinrders of various types
because it is prone to injuriu that may affect its tendons, iE synovial bursae, or iE ligaments. This must not be ignored despite
the complexity and the variety of symptoms presented by various clinical

picturu.

From the preventive point of view it is important to detect general disorders or static constitutional or funclional abnormalities that could lead to degenerative processes in the tr'ssueE or recent traumatic lesions which, however slighg could have the
same consequenc es if neglected.

From the curative point of view, an accurate clinical and radiological diagnosis of the chronic lesion is needed in order to

termine the most appropriate treatnenL


'Theseinfihrationsmunalwaysbecarriedoliunderrgorouslyasepticconditons.

A . MEDIAT ROUTE
Indications

very suitable for joint cf{usion.

IECHNIQUE
Needle :50 mm needle of 8/10 diameter.
Dose to inject : 1 ml,

Infiltration :patient, layingon

his

backwith

knee

lightly flexed.

This route is often painful because of mechanical rubbing of the

kneecap.
The injection site is located:

in the intercondylopatellar sulcus midway betrveen the tip

and he base of

he ptella.

The

nedle

is

insefied

tl

hth

of 2 cm.

d*

.i

- ANTERIOR

ROUTE

Indications : osteoarthrjtis of the knee,


rheumatoid anhritls.

TECHNTQUE
Needle : 50 mm needle of B/10 diameter.
Dose to inject :

ml

Infiltration : the anleromedia routc

is usuallv prel.erred, often

facilitated by slight latefal subluxation oi the patella. The pa


tient

is placed

in the sitting pos tion rvith the leg pendent, or

laying on his back with the knee flexed at about 80".


The injection site is located:

1.5 cm or 2 cm inside and be ow thc apex oi the patell.t

according to ihe thickness of the pannicul!s adiposus.


The needle is inserted perpendicu ar to thc skin or at a slight
ang e, posteriorly and medially.

The needle is insertcd to a depth oi 2 to 3 cm accofding to


the ihickness of the pannicuLus adiposus.

C.

IATERAL ROUTE

lndications : hydrarthrosis or eiusior.

TECHNIQUE
l'{eedle :50 mm needle of B/l0 diameter.
Dose

to iniert : 1 ml.

Infikration :the patient

is laying

on his back with the knee very

slightly flexed.

Ihe injection site is located:


. L Suprapatellar injection (fairly difficult and painful): ln thc intercondylopatellar sulcus about 1 cm above thc patella, according to the thickness ofthe panniculus adiposus.

oi2 cm.
the ntercondylopatellarsulcus,

The needie is inserled to a depth

2. Subpatellar injection : in

mid way beh\een the apex and the base of the patella.
The needle is inserted to a depth of 2 cm.

POSTERIOR ROUTE

Ind icatio ns : popl itea L cyst - eiiuslon (monarth ritls, osteoarth ritis).

TECHNTQUE
N

eedle :50 nm needle of B/10 diametcr.

Dose

to inject : 1 ml.

Infiltration :lhe patient

is placed laying on the abdomen

the knce slightly flexed. The inieftion sjte is located

with

the needleBrazes the medla border oithe condyle and is

pu'

oithc pop ileal space


. the needle is irserted to a depth ofabout2 cm perpendicular
to the skin Check lhat no blood runs back through the necdle
shed doivn to the floor

as

ry:-L

in the medial part of the pop iteal space, just medial to the

tendons oithe semimembranosus and thc scmllcrdinosus.

,,...-..'.-.--.--

thcrc

is ,r risk

of puncluring lhe popliteal vein or arlery (aneurysm).

INJECTIONSAND
INFIUTR/ATIONS

OFTHE SHOULDER
Soft tissue rheumatism : "This most commonly takes the form

of local symptoms which can be app.reciably or completely re-

carried out safely and with the utlieved by tocat injection. However this simple procedure mustbe carefully thought out and
without technical knowmost care : it should not be a reflex ruponseio all localised disorders carried out indiscriminately,
infiltrations must only be
ledge, and anywhere, in a place that is not pefectly clean or on the sports field..Local
risk
by qualified peisonnel under rigorously aseptic conditions; to ignore this rule is to expose the patient to the

adiinktered

of local or perhaps even general infection."


Professor

A.M. RECORDIER

1. lrrfiltrqtion of rhe qcromioclqviculqr ioinr


Ind

itations :sequelae of acromioclavicular dislocation or sprain,

acromioclavicular osteoarthritis.

Needle :25 mm needle of 5/10 diamcter with long bevel


Dose to

inje(t:

1/2 ml.

.lnfiltration :the patient

is placed in the sitting position

is located:
the acromioclavicular joint space : this joint space is
easily identified if the ioint js dislocated or affected by

Ihe injettion site

'in

osteoarthritis.

Thc infiltration is made into this joint space with the needle
inscrtcd obliquely downwards and medially. The needle must
not be inserted to a depth of morethan 1 cm.

.1,,

:|

i,rl

ii

,.,1.
lndications

: frrzcn shouklt'r. r,r;rsrr tis, rhrunt,ttocl rrlhrits,


( l) (x k.
tr,t
nr.rl
ll0st

f,!tcdlt: l5
tlimcicr ntd

nll

P0s!i.
Dlsc io injert

,ltr:l ;'10 rli,lrrtf r) a(l nrnt an,:l 11,10


) lx,lh fl(x,i5 ( )l thr
lt,tnnrr uhs adl-

r,,r r oril n!

1(

nt

rliltratior:lhcpalicntirlr,uul I tlrt:ift

ng |Lrsition u tth lrnr


The nleLtLon sttr : IrL,rlrr1
nttrfll ,ll(, \ lloste iLrl to thf .,1( rottr or l,tl'ir Lr ,rr 1o nl.
. ,rl lhe .rpf\ oi thL' ,rr lle ,,rU e ionl(l l)\ thr, Posler or boxler

,rhd!cl.d

,ri

l;'.

l. ''.r l'.,f . '.' 'r'r


lhr: lt't rl[' r ifselleL] ,lt ln .r0'l r,, ilotnrr,rrds ,lr1 slighl v
l' 1.''

'i

,rler,r

l\

(lo\ n k) t rc r.ll1 l.r

j;qllr,ris1'1

lt,t)r(,n 5ll)Lt

1'

(t thi hf,rtl d tht' hlnx'r

tlli ,trrf/ri,I

ri\|l ,lto (ln lltfili!

us.

r\rr , "'

'r'liiL:.rtr5. : lhf iIlttittis p,rrrr I llrIsill nqlx)s to| \\' ill


llrl srou tlcr s ,qhl \ lit('r,r r fr)l,rlffl.

rs

l|

s (x alr'fl

,rl)r)\f thf,tcfont |( ,r\'r | ,r Jt)|rl.


f lrt neer Jle . ilscrlccl,rl,r il qlrt rI ru rl,,,rri l,tng c unt
rlr

rrrrl,u I ri itlr the he,rrl or

iltt

hLrnl,rus

w:

{
\lI t
I

I
,
t It

(_nt

rL

"''

ii\

''lrr:Lllt .l; f Ir,Ix1li,1i[] (lix|rt0 {rr 5[)nnlr ar](l 11/l0al antctcr


rmclr,rr r orrl nq Lr-r llte Lltrr
ot lltr p,rilt tt us,tdiposls.
'rtcss
l-lo!c lrr Ujr[l . I m.

Thf ini('ctio

."I

'r

clnltcs

It

r'

iilIp|d:'lt]]ffidlll

frlr{:11}rt]J'll i!;l

Indications: frozen shoulder (all

qvpes), capsulitis,

fhcumak)id arthrltis.
Needle : 25 mm needle of 5110 dhmeter with a shod bevel.
Dose

to inje(t

I ml.

lnfiltration : thc paticnt

plaled

1n

thc sining position with lhe

nr. i!hllr,rbdu(1rrl l{) i.

The iniection sit is located :


o

to

rt lh. f[,r5r'.iion l]{rlrr'eer

a pcrpcndlcular line2 cm mcdial


ihe ateral lnrdcr of the acronlon and a horizonta line2 cm

belorv the

in1.er

The need

iftii

or horclerofthe lateral part oithe acromion.

s inserted

pcrpendlcular to th-" skin until it comes

contact $'ith the head of the humerus.

,'i.,i'lir;';-iril!i,ir,il,. ili{i::fll li ii'il;


Indications : irozen shou cler.
Needle : 15 nrm reed e r-rf5/10 diameter.
Dose ro inject

: I ml.

lniiltration :thc paticnt

is placed

jf

the sllling positi0n

$'Lth arrn pefdent.

1 cm beloi,,;

thc nlcrior lnrcler oi the acrr)rrion on the lalern

.rspccl oi thc shoulder {s ightlv posterior y).

Ilrc needlc is lnserLed at a slight anglc, upwards ancl antetiot y,


l)etweef the great t!berositv oi thc humerus ard the intcfior

a[nm]of

aspeci ot the

ffi

| {r4

ir

:ir ri'r ;l

i } t;l I j\l [.i lljliili_iliii

'/-

ti,--

[ 1.ili]d|,,]}

::liF fF'll[i],;,lii1ii,:il'iilril;1.:l;
d0ltrldltis
pla

ns

detded l)t

tl

palpation, alicr the patlentcom

oispont,rncous pa n on alrdLrction ofthc anr be),ond 45').

2l

mm needlc oi

5i

ll

l0 dlanre'tir.

I ml.
tl e prtient

rs placecl

in thc silting pos tlon W th afm

pen(1Lilt.
\liNlrr

opp(,s (r(

lhl r orvlrglnr

to,rbdr(llof 0ilhcamrircilltates iderntficationoi

towads thc

lhc b ccps alrt$ior), rnd thc trircl]s posterlnl]'.

Irl rrrrlr'' irr:r' lcti,rl lhispo rtperpendiculartothe5l(if Lrrrtil


It(1)r)ir,\nlorrlrl,r(1 $'ilhlhcbonealadepth0il, to I cnr.

I
I

Iito

oi thc iibfcs oi the delkrid musr

rl\, lrlwtu

lr

NJECTIONS AN D INFI TTRATIONS


OFTHE ELBOW
Dr. F. Comrnandrc

The elbow is the maior site of soft tissue rheumatic disease.


Many forms of inflammation of aftachment of muscle or ligament to bone or dinrders of the muscle insertions can affect the
elbow (C. la Cava). Epicondylitis is the predominant form of tendon disease, but bursitis and nerve compression syndromes
are also observed. The suruey carried outby J. Cenety (1975) indicated the relative incidences of disorders at this site:

epicondylitis 66%
dinrders of the

misc. bone disorders


the radial insertion of biceps

headofradius 20%
epitrochleaitis 9%
olecranon

A.

pain

TAIERAT ROUTE

Indications :Tennis elbow or Eicondylitis, epicondylalgi4 sprairy

pulled ligamenr
TECHNIQUE
l{eedle :25 mm needle of5/10 diameter.
Dose to inject : 1 ml.

Infiltration : the pain can be located by opposing movement of


the wrist and fin8e6 with the elbow flexed at 90' and the hand

supinated.
a. epicondylitis - epicondylalgia
The injection is made into the site

ofthe pain

either by a fanning movement of the needle in order to distri-

bute the liquid without excessive increase of prcsure at the site

(butthere

is a risk

ofcausing further damage to the musculoten-

dinous tissues),

or at a single point, with fairly deep insertion ofthe needle

until

it comes into contact

with the periosteum.

b. sprain - pulled ligament (radial collateral ligament)


The injection site is located just above the epicondylg mid way
between this and the lateral aspect of the olecranon, and the
injection is made at an angle,
and medially.

pinting

upwards, slightly anteriorly

2%

2%
1%

medial humeral radial


tunnel syndrome
(i

nterosseus nerve) about

1%

B.ANIERIOR
AND MEDIAT ROT,IE
a

Indications: osteoarthritis of the elbow, involvement of


elbow in rheumatoid arthritis, diseaseofthe head ofthe radius,
painful supination in the adult. Intra-articular injection.

TECHNIQUE
Needle :25 mm and 5/10 diameteror 50 mm and B/10
diameter needle with short bevel.

: I ml.
Infilnation: with the elbow extended, the injection site
Dose to inject

is

l.cated along the distal part olthe lateral margin ofthe tendon
ofthe biceps. The needle is inserted perpendicular to the skin
until it
b.

is

felt to encounter the bone of the head ofthe radius.

Indiation : inflammation of the teodon

of the biceps.

TECHNIQUE
l,leedle : 25 mm needle of 5l10 diameter.
Dose to inject : 1 rnl.

Infihration :with the elbow flexed at90', thetendon standsout


on supination of the hanrj. The needle is inserted parallel to
the tendon alon8 its lateral sudace untjl it makes contact with
bone.

c. Indication : Colfers elbor:, or medical humeral epicondylitis


anle'rrr and ncdial route.
TECHNIQUE
Needle :25 mm needle of5/10 diameter.
Dose to inject : 1 nrl.

Infiltration : the site of pain

rs

identified by palpation with the

elbow flexed at90'. The injection

is made

into$issiteof muscle

pain, the needlebeing insertd until itencountersthe periosteum.


This ensures that the needle remains clear

ofthe ulnar nerve in

the sulcusformed by the medial epicondyle of the humerus and


the olecranon.

d- Indication: infiltration of the ulnar collateral ligament.


TECHNIQUE
Needle :25 mm nccdle of5/10 diameter.
Dose to inject : 1 ml.

Infiltration : great care

is needed here because of the

proximi-

ty oi the ulnar nerve on the posterior aspect 0fthe medial epi-

condylc of
tion sitc is

$c

humerus. The elbow is flexed at 90'. The injec-

locikd directly anterior to and slightly inferior

to the

tip oithc rnediai epicondyle ofthe humerus. The infiltration

mad('between the skin and the surface ofthe ligament.

is

C. POSTERIOR

AND IATERAT ROUTE


Indications: tendonitis and bursitis ofthe triceps, hygromas
of the elbow.

TECHNtQUt

Needle:25 mn needle oi
Dose to injert : 1 ml,

srlg6;rr.,.r.

Infiltration :ivith the elbow extended a nd the triceDs tensed, the


ofpain are located by palpation aboveand alongthesides

sites

ofthe olecranon.

Ihe injection site is located:


a. for tricipital tendon

rtis : arou nd the sites of pain, avoiding the

lendon.
b. for tricipital bursitis : with the elbow flexed at 90' identili), the
epicondyle and olecranon. The injection s'te is located beneath

theepicondyle. The needle is inserted perpendicular tothe skin,


pointing downwards, posteriorly and medially.

c. avoid infiltration for hygrcmas of thc elbow. li this is not


possible, asthe hygroma is essentialiy subcutaneous, inject l ml
directly beneath the skin.

D. POSTEROIATERAI ROUTE
Indications : disorders affecting the head of the adius (epicon- dylalgia), osteoarthritis of the elbow, involvement of the elbow
in rheumatoid monarthritis 0roJigoarthritis.
r

TECHNIQUE
Needle :25 mm needle of5/10 di;meter.
Dose to inject

: 1 ml.
Infiltration : the elbow

is flexed at about 90'. The injection is


made intothe radio-ulnarsulcus perpendicu lar to the skin, i cm
beneath and anterior to the inferior border of the epicondyle.
The needlc is inserted 1.5 to 2 cm into the superior radio-ulnar

joint c.rpsule.

B.WRISTJOINT
lltliraiions : sequelae of injUry (sprain, injury to the wristor wrist
joint), synovitis, rheumatoid anhritis. Osteoafthritis ofthe wrist
(very rare).

TECHNIQUE
,nli.edle : 25 mm needle o{ 5/10 diameter.

!oJ I to iiiioci : l/2 to

ml.

liiirlurticii :the wristjointspace

is identified through the skin on

the dorsal aspect ofthe wrist, with the hand pronated and resting

on a table or hard surlace.


e. stylold process of radius
A compressible region, which is ollen swollen (acute 0r chronjc

inflammation) is usually readily identified by touch, behveen the

distalextremity oithe radius, the lunate and thescaphoid bones.


The lnjection is nrade about 2 cm (one finger's width) from the
styloid proces ofthe ulna. The needle is inserled perpendicular
to the skin and then ang ed upwards with the hand kept pronate

lo opcn the joint.

f,gi..il]0F.I :care nrust be taken to avoid the veins in the dorsal


side of the wrist and the hand. Painful reactions are fairly com-

mon because ofthe distension ofthe joint capsule lthe injected

amoift plays a part here).

[.

st,vloid proccss of the ulna

Same principlc, but in this instancethe injection is nude bt'l^/een

thc distal extrcmiry ofthc ulna and thc triquetral bone.

DISTAL RADIO.UTNAR JOINT

!,,r1{ri!olrs

: osteoaft hritis, sprain.

TECHNIQUE

fifldjr

:25 mm needle of 5/10 diameter.

!l:e rr; rnlcri : 1 ml.


rliriir:iilr : the hand

is p aced

flaton

a hard surface.

After locating the base of the stvloid process of the ulna and the
radius, the injection is made about 2 crn irom the border of thc
ulna. The need e is inserted perperdicular to the skrn.

D - CARPOMFTACARPAT

JOIT{TOFffETTIUMB
Indications

osteoarthritis oithe base oithe thumb, lr,ery rarely)post-

traumatic sequelae LspIa n, dis ocation...).


TECHN QUE
Needle :25 mm needleoi5/10 diarneter
Dose ro inlcct :

li2 to 1 mL.
Infrllration: the iirsllretacarpaibasc is ocated on thcback ofthe
hand. The osteo-articu ar intersection formed bv the
cond mchcarpal bones and the napezium

is then

fint and se-

identiiied by pal

oiten painfLrl. The n1,"cl0n is made Frpendlcu arto


the skin, graz ng the atera J border oi the i r( nreLicarpa L The necdle
pation, ivhich

passes

ilt

lleh{een the lrapezlLrm and the heads ofthc first ard second

metacarpals. The

injcction s olten palniul.

ffi '," fffi ETACARPOPHAJhNGEAT

AI{D

II{TERFT{A,TANGEAI- JOINTS

lnditations : osteoarthr tis oithe fingers; metacapophalargeal


i0ints irare) and distJl interPhaLafgeal ]oirrts : I ieberden's nodes;
proximal intcrphaLangeaL joinls : Bouchdrd's nodes, iheuma

toid arthritls, l)osftraunratic seqlelae.

IECHNIQUE

nnr needlc ot 5/ l0 diameter.


injeri : l/l ml.
Infiltration : the iniection is nrade irto lhe joint spare or the

eed le : 15

"l

Dose ro

dorsal sidc of the finger, to the side oi thc cxtcnsor tendon ilate
ral y

r-rr

necdle

nrcdiallvlgrazingthc mctacarpalor phalangeal head. fhe


s lnserted at an

fingen. Thls injection

angletowards the d stalextrcmitles oithe


niul. Cryoanaesthesia ($,ilh cryo

is i,ery pa

iluorane) is rcconrnrendecl.

iff4:!flffith,fi",

lndications : lrr ht

of,

ll]h[AlAl{GFAt pADS
fllanrmat of, bursitls.

TICHNIQUE
Needle :

2i

mnr nced e oi 5/10 dianreler or vcry f ne and short

intradcflrir need r.
Do5t to inj3ct

lll

ntl.

lrfiitration : lhc prds aie on the dorsal irce c-ri the proxinral
irtcrphrhngr',rl loinls Ihe.v are oi soitcr consistencv than
lirLr lr,rrrl's
in

jt'r t

rrr

xlcs,

irrlr

wh ch thev should be distinguishcd. The

s rr,rr[' l,rteralLr',,rl thc base oi thc pad,

lr' ;. ,.rr r.r

' .r'l ;. | .

n ihe region

of

7I

f .-'.;--:,'.'::,

2. Lqlerol ospecf
A . SIYIOD rc(ESOFIHE MDII'S
Indi(ations : radial styloiditis,
TECHNIQUE
Needle :25 mm needle of5/10 diameter.
Dose to

inje(t:12 to 1 ml.

Infiltration : identify the contour ofthe styloid process ofthe


radius on the lateralaspect ofthe hand; jt is painfulto pressure
dnd_somerimes shows signs of inflammarory

sweljilg. siloiditjs

otlen dsso(iated with inflammation ofthe lendon ofthe lorg


fleror oflhethumb or De Quervain s lenosynovrtis. The injeaioi
rs made dtrertly againsl the bone where rhe pain is
localised.
is

B . TENDON SHEAI}IS

OF

ME

TONGABDUOORANDTHE
SHORT DfiENSOR OF THE THUMB
Indications : De Quervain's tenosynovitis.
TECHNIQUE
Needle :25 mm needle of5/10 diameter.
Dose to inject: 1/2 ml.

In[iltlation :it
mical snuffbox

is essential to recognise the

outline of the anato-

r anteriorly it is bounded by the tendons of the


abductor polli_
cis longus and the extensor pollicis brevis in their common
synovialsheath; in cases ofabarticular inflammation there is :

swelling with or without crepitation on palpation and on

active movement of the thumb,

orsimply stenosis and pain,

posteiiorly the snullbox

is

lmunded by the extensor pol)icis longus,

and its base is formed by the styloid proces of the radius


the scaphoid.
It js important not to forget that the

ind

radialartery and is branches

pass through the distal part of the anatomical snufibox.

The injection is made into the lateralface of the wrist and hand
at the tip ofthe styloid process of the radius, the needle being
angled upwards in order to pas into the synovialsheath.

3. Pclmqr
A.

CARPAITI.,!f{NEI.
cr

rP,r I

tun

ne

svnd ranre, reiracklry acfoparrcslhesia.

TECH\QUE

li

mnr nccdle oi

ir'l0 diamctc'r.

tnt.
the hnnd Jfd wf

c ther the

ot the second I

nfd

are exam

ll ,l .l n, Ln r' tt .l !l " t.n.i,

ln, .,t'

n the r,rnter or

or

aftefiof llrberclc oi thc scaphoicl,

errrc

inc on thc skln frorn the palnt on lhc

dfter/or ispccl ot ilre wrlsl,

. orthcs(rlo

d process oithe radius.


Ihrtc nr(,tlrods oi irjertion ma! lr usccl

re alive to thc Jnterior tulrrclc oi trc scapho d.


Alons;r horizontal fc I()m lhe ffter or tLrbefc c to thc pisrtonr bone, thc injelion is macle one i n,ter's lviclth nrcdhl to the

tul)ercie, rnal just fredial to the palmlr s longus rvhrah Iorms one

sidcoilhechanne ior the r,rclhl artcn,. Tho need e is nserted al


.rn angLc po nt ng cloivnu,ads, nx,dh ly and postcfloriv to\\,ar[]s
lhc ilrrs{'r5, ti).r d0pth oi I i to 2 cnr.
relat l,e to thr mcili,rl

flexlre line on the anlerior sud.tce of

the \\,ri\1.
Th-" inje,ctiirn is

nrarlt,nt-"diit Iothc lnterse(lol oithisilt'rrrrc line

.rnrlthepalnraris brtvis Theneedle

angkrlvet

shar'p v

doivn

rurrrh, redlal ,, and posteriorlv tovr.rrcls thc tingcr in ofilef to


J\roi.lihf nrrcliar f0r!c. lt js ijtcedcd to i depth oi l.; k) 2 (jm.
ft.

.r1

\,(' lo tlrc

.pe\ oilhe

stv o d p ocess ol the fadius.

llrf

nif(tlon i! m,tdr.J to,1 mn p()rim,rl totheaperoithc


slr o 11 prori,ss oi thc r,rdius, in lhe su cus iornted Lry thc
tcrdons oi thc palnr,rris ongus rnd the palnr,rris hrcvis. I he
reecl e is nscrtc,cl ,rt ,rn lnqle, ntccliallv. rllrnwarrls lncl
po(crior \'.
N.fl. : \('l'or cls onallv lhe rccd c prnft!res the med af

r('!t'

a.ru5 r1t sharp

Irrxr& u
l)o! lior.

pl

th thc injeLt

r i this slrould

or

L)ui

hrppen do nol
mo\c thc fccdlo lo,tnotlter

B.

UTNAR NERVE COMPRESSION

l:r

.irit

ulnar nerve compression.

TECHNIQUE

li

mm needleol

l/2 to

"

5/ uoramelcr.

1 ml.

identiry the plsitbrm bone, the tendon ofthe flexor

carpi ulnaris and lts insertion.


The lnjection is made at a sharp angle later;1ly to the tendon of
the flexor carpi ulnaris, clownwards and slightlv posteriorly.

The needle is inserted to a depth of 1.5 cm.


lf the ulnar

nerveorthe ulnarartery

is

accidentally punctured do

not proceed rvith the lnjcction but move the needle to another
posilron.

C.

TRIGGER FINGER

Indications : tenosynovitis of the flexor muscles of the finger.


"Trigger finger".

TECHNIQUE
Needle :25 mm needle

of5/j0 diameter.

to inje(r : 1/2 to'l ml.


Infilnation : the nodule on the tendon of the flexor
D

ose

palpatiOn,

lsually

is detected

in front of the metacarpophalangealjoint,

by

and

on active movement ofthe finger.


The finger is very slightly flexed.

The needle is inserled opposite the metacarpophalangeal joint


at a sharp angle, posteriorly and downwards until it reaches
the nodule to be infiltrated.

DUPUYTREN'S CONTRACTURE

Indicatioul

lLtpgytrgn's contracture.

TECHNIQUE

lleedle :25 mm needle of 5/i 0 dianreter.


0ose io

irle(t .l/2

to

ml.

infii ra ti0 n : pa lpation reveals the aponeurotic bands


and nodu les

e'0'elr.rL 'ile paln dr aponeuro'irrs DupLrl tren s direa.er.


The injection is made into the nodules and bands. lt is often

oi

difficult and painful. Aponeurotomy has rendered this treatment


ress useruL.

The injection must be followed by vigorous but controlled


extension of the retracted fingers.

s".

DIPROFOSlbtomet|oonediorooionole ond betqmeAoone disodium phosphote)


indtot nr, doroq" dnd odtinirhclion : DIPcOFOS i5 rcco.nmended b { I I nno-uscl o' r edior ir oolierh rcourng
inlec or lo' lhp reot
rv:temic co-icovet d {eropv l2l dreo rni*tion iro $e ollectd soh fitsues, {3) ilro- or pef-or'cJlor
'ii"i'ion ro J i. bsio"s: ond (5) ocol odmiristrot or lor the treo-enl ol vorious cvslic ord
faf ai'*i
"i"it, 'i.,diorderr of the fooi
,nllommotor
l. 5dt tirsue ond mus(ubrl&toldircrder: Rheumotoid odhritis, osteoodhritis, bursitis, onkylosing spondvlitis, epicondylitis, rodiculiiis, coccydynio. lorlicollis, sciotico lumbogo, gonglion cysf, e-xosirsis,
'Dosoqe '
nieo,or 0 25 n 2 mi ctording b he size ol he orl
I o 2 ml by deep lM iriec'on.
fosciiris.
'ntro-orticulor
2. Alkok diroid"" Ch'ont bronchiil os'h.o linciudinq odi,rnctive theropv for stottrs osrhmoticus),
ho' feJer. onoioneurotic edemo, ollerqic bronchitis, seo-sonol o' perenniol olle'gic rhinilis drug reocrions. serum ilckness, insea b;res. llo hnefic olos odincnil|eropy n slotus or*rmoticLrs. Dosoge: I lo 2 mlby

r""

deep lM iniecflon.

ili" a;tl"t", ar"oi. a"rrnoliis lnvmmuloreczemo), neurodermotiiis (circumscribed lichen simplex),


necrobiosis liooidico dioheticorum, olopecio oreolo, discoid lupr-rs ery*'emotosr,'s, psoriosir, keloids,
oemohiqus dermotitis heroetibrmis uricorio, \ypertrophic lic\en Plonus, conlocl dermofiris, seve'
ocne Dosoge o ? ml by deep lr'r irir on Di'ecl rrrooeric ir iec or irb Ae les on
i" iJf"r"a"ir"riti.,

i.

"r'f.

of 0 2 ml/cm? uo to o moximum of

l,

ia.g""

ai*"

ml per week.

Disseminoted lupus eryhemol,cs,-rs, sclerodermo, dermotomyosilis, Polyorleriis no-

doso. Dosaoe:lb?m

bv deep Mlnleclion

otlriil;"tu"r,ti;;""irol

syndrome, ulceroiive colitis, regionol ileitis, sprue, podiotric condit'ons {bursilis under helo#o durum, hollux 'igidus, digiti quinlivorus) drsorden requiring subcon
i"i*ri.". -'ri.osteroid responsiuellood dv"scrosios nephri[s ond nep\rolic syndrome
cdrenocortitol ins,,fficiencv nov be treoted with DIPROI-OS Sterile Aqueous
brimorv o,
'econdorv
'
Susoeision bur should be s,.,pple'nenhd wi$ r'rinerclocorticords Dooge b 2 ml bv deep M n ector
dridLol
lE'rierenrs,
ooierf5
lod
b
fie
m,rsl
&
b
ruhrcul'n
syr
nge
do'oqe
.
oy
odm
st'eo
'l'e
0.25
-l
Lcro]ry
$" ,.',e, ol{e d oroe,. {" ,"pne ono {e po[irr s oo lirv olerole hp cor oseroid llre* of$e p'oPemes ol Dl

i.

i*.i,i.i

DIPRO
PPOFOS'corc"re" ocoiono.,iles,o"i.lhreqr,edorlT-orelyfcolcJ'Ierluseoforonoslrercisdesirobe
fOS mov h -ixeo n tle sv;rqe lro r *e ompoulel -iF procorre hC r% or 'rdoco n" HCI I %
& odr" sre'"d inr,o"eno ny. .r...rsr oe oo-inisrr"d urcer . gorcr. y oseptic .ondi ons
C"J-' O,|,CO;OS
hcue sfo*n thot locol oi qenercl rreotmenr w fi D PROFOS s *ell toleroied There ls
r'ioh
Si*-"tt*tt , r".""i c|l"i.a

-"r*'

{o side eFe.rc\o'ocle isric or{" co- cosrelo'd dr,gs -01de'eop howeues'ile.eff*ts retoted u dole ond durolion of heolmenl ixlude Cush'rg's syndrome, od,enol suppresion (specio
precou.ors o'e rxessory d.:.rnq drets adLcdby5rge] -oumo or se''our diseo,e) osleotoosis gosl'(uke'w'\
; + of pcro'olio r o1d .oenorrroq" d'sr,rbo rce o[ glucose m obo[sm wilh $ ocerbo'on ol diob'es -e li'us: e 'ocer
o,;i*'i". poie.r cotobo.nm r eqotrye na.ogel oo or(e go*h e.odo o" rr cl,Ldren poly'
borlo"'.,

*ovso

The

:""

,il

^o

ohoo'oossociori"rr*eqfq"nordoed.r"o,''e*or{ep'oong"docriorolDoROFOSordthe'esitirgrhlb
-oy lr okop"i o{ feodrerolco-e, ol-e' t'eo'-erolo le* -eeLs ord
tron iferooqeroL s od'e.olixie or the
'"

mov

L"t"

oenislbr

ku-i

tid"*fi".rt

r"ntl

lor up loone yeor

some monlhs or even

disorders, spontoneous hocbres, mus.le diseose, rolsed nho oculor pressure' olrophy

ol tle s[]n or subcutneous lissue, ord menstruol disir:rhonces


Controindkdio : wi$r lhe exceplion of o few spec ol s tuot ons fiol hove o senous prognosis tuch os 5p no blod, hypo
l{ tfiey hove to
rension ond dyspnoeo, fie corticosteroids ore os o generol ru e conlrondicokd in qolienlr w tl i Lbercrlosir

urcd tr.rbiculostotic cover musl

wovs be qiven concLirrm


16r

ro lv considered to be onrroindicotions

HeFes simple, ol lhe eye ond ocul psychosrs ore gEne


Ln polienh olle c lo one o.

coriiiosteroid r|eropy. DIPROFOS is conlro ndicoied

nle$ no ono
moie of its inqredienis Otlrer conko ndicotlons : oclive or olenl goslr'c lkerolion primory gloucomo reni
reno iorlLre
,toros,s. o'ue_'c., lis lyplerso. rl'o'bopl ebit' o'reopo osis d oberes C"J^ rg s 'yndtome

oy

cl'oti croer

o.do.:"o' c. onc

oo

h rreornn.y col cossod *e'opy m,"s

t"qol rle.ior' br *\,c1" oopoonoo,'mf_err s rotovoiloble


_'- efle'a do5e MTn 51olor
et-ceo I,ero.,s disordes or d gva r tle 'i

eror u'o

or

o{DPIO-O) ro p eqnon' -o-"^ m,; oe ouod.d e,peciolfdu'"grfeIr'tet coni' oieroid lh"roPl


p'eqio. , 'lre reorol" n:stbe o etr y e omi 'ed ror sy^ o o^ ' ol odrero oi co
ceso', d.
'.q
.srFiu..vo"d,f-{'e."o'"ro".o
opprop'oe lrco-e1'-Lsl b" uer rmned oelv
L

<O DIPROFOS

so regirrerql todemorl o{

SCHER

NG PIO1JGH Corp

USA

wos 1"'

DIPROFOS

RAPID RELIEF

LASTINC RELIEF

PAINLESS INJECTION

SAVINC OF CORTISONE

t*=E;:3t

=---

- -:F.-:!, -

.-

''''t

PRoVIDED AS A PROFESSIONAI SERVICE


TO THE MEDICAI PROFESSIONAT,

A
Schering-Plough Corp.

-I-s"h",ins Plough, Kenilworth, New Jersey, U.S.A.