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
Which joints? Knee Shoulder (3 approaches) 1st CMC 1st MTP Radiocarpal Sternoclavicular
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
Contraindications Local infection - septic arthritis, cellulitis Systemic infection - eg TB Psychosis Pregnancy up to 16w
General principles Accurate diagnosis Relaxed patient Mark skin Aseptic (no touch) technique Aspirate first Know the feel
Which steroid? Hydrocortisone Acetate 25mg/ml Methylprednisolone acetate 40mg/ml Triamcinolone hexacetonide 20mg/ml
Local anaesthetic? Usually lignocaine 1% Occasionally long acting Usually mixed
How much? Half or one
How often? No more than 4 weekly intervals No more than 4 times a year
Post injection advice Rest 2-3 days Mobilise
Complications Steroid flare Infection Skin and fat atrophy tendon rupture (hereditary)