1. Joint Injections علیرضا احمدی متخصص بیهوشی، فلوشیپ درد

2. Joint Injections 1.Intra-articular 2.Periarticular Injections: 1.Corticosteroid 2.Local anesthetics 3.Viscoelastic supplementation

3. 1.Shoulder 2.Hip 3.knee joints 1.Indications 2.Various techniques including those with imaging modalities 3.Complications

4. INDICATIONS 1.Osteoarthritis 2.Adhesive Capsulitis (frozen shoulder) typically occurs after prolonged immobility of the arm. It can be associated with diabetes and thyroid disorders. Remarkably, findings on radiography will often be normal 3.Rheumatoid arthritis SHOULDER JOINT

5. TECHNIQUE Blind: 30% Both ultrasound guidance (USG) and fluoroscopy: 65% to 90% Anterior or Posterior approach

6. Blind Anterior Approach:

11. INDICATIONS 1.Osteolysis of the distal clavicle a degenerative process that results in chronic pain, particularly with adduction movements of the shoulder and is typically seen secondary to traumatic injury or in persons who perform repetitive weight training involving the shoulder. 2.Osteoarthritis ACROMIO-CLAVICULAR JOINT INJECTION

12. TECHNIQUE 1.Blind : 40% 2.Fluoroscopic: 100% ACROMIO-CLAVICULAR JOINT INJECTION

15. HIP JOINT Knee pain was reported by 18% Hip pain by 7% The most common: osteoarthritis inflammatory arthritides: 1.Rheumatoid arthritis 2.Psoriatic arthritis 3.Trauma infection 4.Avascular necrosis

16. TECHNIQUE The anterior and lateral approaches are the most commonly used techniques However, neither technique can be reliably used without radiologic guidance although the lateral approach is thought to be safer than the anterior approach. 60% success rate with the anterior approach 80% success with the lateral technique

17. KNEE JOINT Osteoarthritis of the knee is the most common form of arthritis and the major cause of disability and reduced activity in people older than 50 years. Thirty percent of people older than 50 years have radiographic evidence of osteoarthritis of the knee, which increases up to 80% after age 65. While men have more knee osteoarthritis before age 50, its incidence increases in postmenopausal women such that by age 65, the prevalence is twice as high in women as in men.

18. KNEE: INTRA-ARTICULAR INJECTION TECHNIQUE Midpatellar Approach Anterior Approach (Infrapatellar) Suprapatellar Approach Fluoroscopic Approach Ultrasound Suprapatellar Approach

19. A, Suprapatellar approach. B, Midpatellar approach. C, Infrapatellar approach.

20. COMPLICATIONS Safe, Comfortable, valuable tool in the management of musculoskeletal pain 1.Infection, the most serious complication, is extremely rare (0.03%). (avoiding injections in patients with suspected cellulitis, infectious arthritis or bursitis, bacteremia, or in severely immunocompromised patients, hyperglycemia ) 2.Hemarthrosis is small even in those taking antiplatelet or anticoagulation agents 3.Steroid-induced Arthropathy developing after multiple 4.Capsular (periarticular) calcifications at the site of the injection have been reported in rare cases on radiographs taken after treatment. 5.Localized subcutaneous or cutaneous atrophy (2.4%), depigmentation (0.8%), localized erythema and warmth (0.7%), and facial flushing (0.6%).