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JOINT AND SOFT TISSUE INJECTIONS

Learn about joint and soft tissue injections, their indications, techniques, and complications to provide effective diagnosis and therapy for conditions affecting joints and soft tissues. Understand the importance of accurate diagnosis, proper injection methods, and post-injection care.

judithhollingsworth
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JOINT AND SOFT TISSUE INJECTIONS

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  1. JOINT AND SOFT TISSUE INJECTIONS

  2. Aspiration • For diagnosis - gout, blood, (pus) • Therapeutic - relieving pain

  3. 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

  4. Which joints? • Knee • Shoulder (3 approaches) • 1st CMC • 1st MTP • Radiocarpal • Sternoclavicular

  5. 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

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

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

  8. Which steroid? • Hydrocortisone Acetate 25mg/ml • Methylprednisolone acetate 40mg/ml • Triamcinolone hexacetonide 20mg/ml

  9. Local anaesthetic? • Usually lignocaine 1% • Occasionally long acting • Usually mixed

  10. How much? • Half • or one

  11. How often? • No more than 4 weekly intervals • No more than 4 times a year

  12. Post injection advice • Rest 2-3 days • Mobilise

  13. Complications • Steroid flare • Infection • Skin and fat atrophy • tendon rupture (hereditary)

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