JOINT AND SOFT TISSUE INJECTIONS

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JOINT AND SOFT TISSUE INJECTIONS
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Aspiration

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

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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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Which joints?

• Knee
• Shoulder (3 approaches)
• 1st CMC
• 1st MTP
• Radiocarpal
• Sternoclavicular

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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

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Contraindications

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

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General principles

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

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Which steroid?

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

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Local anaesthetic?

• Usually lignocaine 1
• Occasionally long acting
• Usually mixed

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How much?

• Half
• or one

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How often?

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

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Post injection advice

• Rest 2-3 days
• Mobilise

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Complications

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