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JOINT AND SOFT TISSUE INJECTIONS

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.

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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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