Injections

Question 1

Indications for Injections

Answer 1

Osteoarthritis
Rheumatoid arthritis
Gouty Arthritis
Synovitis
Bursitis
Tendonitis
Muscle trigger points
Carpal tunnel syndrome
Wound anesthesia

Question 2

Describe Local Infiltration

Answer 2

Injecting into the subcutaneous tissue of open wounds

Question 3

How to clean & sterilize the wound?

Answer 3

Clean it enough
Perform injection
Scrub the skin

Question 4

What medication decreases blood loss?

Answer 4

Epinephrine

Question 5

Describe a Field Block

Answer 5

Inject a diamond around the wound

Question 6

How does one perform a field block?

Answer 6

Skin prep
Inject slowly while advancing the needle
Pull needle almost out and switch directions
Repeat on other side

Question 7

How to Perform a Digital Block

Answer 7

Start dorsally

Go down proximal phalynx

Question 8

Caution with Digital Blocks

Answer 8

Use of epinephrine

Question 9

Indication for Trigger Point Injections

Answer 9

Inflamed tendon or bursa by a bony prominence

Question 10

What ortho issue has pain with resisted wrist dorsiflexion?

Answer 10

Tennis elbow

Lateral epicondylitis

Question 11

What ortho issue has pain with stretching of the lateral side of hip?

Answer 11

Greater trochanteric bursitis

Question 12

What is ischial tuberosity bursitis due to?

Answer 12

Prolonged sitting

Question 13

What ortho issue has pain with resisted flexion?

Answer 13

Ischial tuberosity bursitis

Question 14

Aftercare for an Injection

Answer 14

Rest
Ice
Anti-inflammatories
Resume conservative stretching

Question 15

Why inject joints?

Answer 15

Inflammation

Question 16

Inflammatory Conditions that Benefit from Injections

Answer 16

DJD
Bursitis
Tendonitis

Question 17

How does corticosteroid injections help decrease inflammatory reactions?

Answer 17

Limit capillary dilatation

Vascular permeability

Question 18

Risks of Joint Injections

Answer 18

Infections in healthy patients
Soft tissue inflammation
Acceleration of a septic joint
SubQ atrophy & skin depigmentation
Steroid flare
Exacerbation of Dm
Cartilage damage
Tendon rupture
Allergic reaction
Anaphylactic reaction

Question 19

Describe a Steroid Flare

Answer 19

Facial flushing
First 24-48 hours
Clears in 1-2 days

Question 20

Contraindications for Injections

Answer 20

Adjacent osteomyelitis
Evidence of bacteremia or febrile illness
Hemarthrosis
Impending joint replacement (days)
Infectious arthritis
Joint prosthesis
Osteochondral fracture
Periarticular cellullitis/severe dermatitis/soft tissue infection
Poorly controlled DM
Uncontrolled bleeding disorder or coagulopathy
Clotting disorder & anticoagulation
Broken skin or cellulitis over injection site
Joint infection
Immunosuppressed patients

Question 21

When to inject with caution?

Answer 21

Charcot joint
Tumor
Neurogenic disease
Active infections
Hypothyroidism
Bleeding dyscrasias
DM

Question 22

Things to Include with Informed Consent

Answer 22

Risks
Benefits
Expectations

Question 23

Risks of Injections

Answer 23

Infection
Bleeding
Allergic reaction
Pain

Question 24

Benefits of Injection

Answer 24

Simple office procedure

Question 25

Expectations from an Injection

Answer 25

+/- help or only for a few months Increased pain for a day or two after injection May take several days to take effect

Question 26

Why are deep local injections not recommended for anesthesia?

Answer 26

May enter joint space | May alter synovial fluid analysis

Question 27

Short Acting Steroid Preparations

Answer 27

Hydrocortisone | Prenisolone

Question 28

Long-Acting Steroid Preparations

Answer 28

``` Kenalog Aristospan Depo-Medrol (methylprenisolone) Decadron Trimcinolone acetonide ```

Question 29

Combination Steroid Preparation

Answer 29

Celestone Soluspan

Question 30

How do you know when you are in the joint capsule?

Answer 30

You will feel a pop

Question 31

Why aspirate the joint prior to injecting?

Answer 31

Make sure your not in a vessel

Question 32

Knee Injection Site & Usual Dose

Answer 32

S: superolateral D: 40 mg

Question 33

Types of Shoulder Injections

Answer 33

Intra-articular Subacromial AC joint

Question 34

Indications for Intra-articular Shoulder Injections

Answer 34

Arthritis Rotator cuff tear Frozen shoulder

Question 35

Indications for a Subacromial Injection

Answer 35

Rotator cuff tendonitis | Bursitis

Question 36

Indications for AC Joint Injection

Answer 36

Inflammation | Arthritis

Question 37

What is the most common route of shoulder injections?

Answer 37

Posterior with patient sitting

Question 38

How is an anterior shoulder injection performed?

Answer 38

Patient in supine position Below clavicle & lateral to coracoid Beware of brachial plexus

Question 39

Position of Patient for an AC Joint Injection

Answer 39

Sitting | Hands behind back

Question 40

Joint Injection Aftercare

Answer 40

PROM Immediate relief is temporary & may take a couple days for steroid to take effect Ice/OTC anti-inflammatories Call: signs of infection/allergic reaction