1. JOINT AND SOFT TISSUE INJECTIONS

2. Aspiration For diagnosis - gout, blood, (pus) Therapeutic - relieving pain

3. 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

4. Which joints? Knee Shoulder (3 approaches) 1st CMC 1st MTP Radiocarpal Sternoclavicular

5. 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

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

7. General principles Accurate diagnosis Relaxed patient Mark skin Aseptic (no touch) technique Aspirate first Know the feel

8. Which steroid? Hydrocortisone Acetate 25mg/ml Methylprednisolone acetate 40mg/ml Triamcinolone hexacetonide 20mg/ml

9. Local anaesthetic? Usually lignocaine 1% Occasionally long acting Usually mixed

10. How much? Half or one

11. How often? No more than 4 weekly intervals No more than 4 times a year

12. Post injection advice Rest 2-3 days Mobilise

13. Complications Steroid flare Infection Skin and fat atrophy tendon rupture (hereditary)