Splinting/Joint Injection Lab

Question 1

What is the purpose of injecting a steroid?

Answer 1

Pain relief at the site with minimal systemic effects via suppression of synovial inflammation

Question 2

Primary 4 indications for injections

Answer 2

• Severe OA
• RA
• Inflammatory dz: Gout, Psoriatic arthritis, spondyloarthropathy
• Subdeltoid bursa or rotator cuff tendonitis

Question 3

Main 2 indications for aspiration

Answer 3

• Large hemarthrosis
• Synovial fluid analysis

Question 4

When is joint injection CONTRAINDICATED?

Answer 4

• Tendon rupture/risk of
• Periarticular fx
• Periarticular osteoporosis
• Joint instability
• Infection (cellulitis, periarticular osteomyelitis, septic arthritis)
• Prosthetic joint components

AKA if the site is pretty risky

Question 5

In what kind of conditions should we be wary of using steroids for joint injection?

Answer 5

• DM
• HTN
• Osteoporosis
• Joint replacement

Question 6

What must you obtain prior to joint injection!

Answer 6

Informed consent

Question 7

What are the usual complications of joint injections?

Answer 7

• Postinjection pain
• Iatrogenic infection :(
• Soft tissue injury

Question 8

How many steroids injections annually?

Answer 8

3-4 max per joint per year

Therefore around every 3 months on average.

Question 9

Two top steroids for injection

Answer 9

1. Methylprednisolone (Depo-Medrol) 40-80 mg/mL
2. Triamcinolone (Kenalog) 20-40 mg/mL

Question 10

How do we anesthetize the SQ tissue?

Answer 10

• 25-27G 1 inch needle with 2-5 mL of bupivacaine/lido
• Topical ethyl chloride spray
• Mixing lido with steroid

Shoulder and knee may take up to 10 mL of solution

Question 11

Choice of needle size for steroid injection?

Answer 11

• 25-27G
• 5 mL syringe
• 1.5 inch needle

Question 12

Choice of needle for aspiration?

Answer 12

• 18-20G needle
• 5-20 mL syringe
• 1.5 inch needle

Need a bigger needle since we are drawing synovial fluid up!

Question 13

What do we prep skin with prior to injection?

Answer 13

• Alcohol
• Iodine
• Chlorhexidine

Sterile technique

Question 14

Pt education after joint injection

Answer 14

• Ice it
• No strenuous activity x 48h
• Advise on signs of infection and return precautions

Question 15

4 approaches for knee injections

Answer 15

• Lateral retropatellar
• Medial retropatellar
• Anterior
• Suprapatellar (for suprapatellar effusions)

Question 16

Where is the lateral access point?

Answer 16

Junction of upper and middle third of patella

Apply pressure medially and poke in the groove.

The superior dotted line

Question 17

How do you aim the needle for the lateral retropatellar approach?

Answer 17

Slightly medially and inferiorly

Question 18

Where are shoulder injections performed?

Answer 18

Glenohumeral joint

Question 19

Once your needle is in, what’s the first thing you do?

Answer 19

Aspirate to check for blood.