View
217
Download
0
Category
Preview:
Citation preview
Hip/Knee Injection
Mr Andrew Armitage
Horder 2013
Hip injections
• Trochanteric Bursitis
• Meralgia paraesthetica
• Intraarticular - Diagnostic
• Target injections - iliopsoas
Trochanteric Bursitis
Trochanteric Bursa
Incidence
• 1.8 per 1000 per year
• 4th to 6th decade
• Women
• Obesity
• Low Back pain
• Osteoarthitis
Causes
• Very often no clear cause
• Trauma
• Microtrauma (overuse)
• Osteoarthritis
• Post THR
• Leg length inequality
Presentation
• Patient usually complains of hip pain
• Pain over lateral side of hip (over trochanter)
• Pain when lying on side
• Worse with flexn/extn, increased activity
• Not usually in groin
• Can radiate down lateral thigh
• Post surgery
Differential Diagnosis
• Trochanteric bursitis
• Snapping Iliotibial band
• Back pain / radiation
• Hip arthritis
• Meralgia Paraesthetica
• Gluteus medius inflammation
Investigation
• Rareley required initially
– Pathognomic-pain over trochanter
– Ultrasound
– Hip Xray
–MRI
Treatment• Conservative
– NSAID
– Analgesia
– Reduced activity
– Topical anti-inflammatories
• Physiotherapy
– Massage
– Ultrasound
• ESWT
– Shockwave therapy
Treatment
• Injection
– Local anaesthetic – 10ml 0.5% Marcaine
– Steroid - 80 mg depo-medrone
– Big needle
– Relaxed Patient
– Target point
– Hit bone
Treatment - outcomes • Conservative
– Majority settle
• Injection
– 60 – 90 % success
– Can take 4 wks
– Can be repeated
• Surgery
– Very rarely indicated
Meralgia paraesthtica
• Lateral cutaneous
nerve of thigh
• Tinnels
• Neuralgic pain
Knee injections• Intraarticular
– Osteoarthritis
– Inflammatory disease
– Chondromalacia patellae – be carefull
• Extraarticular
– Pre-patella neuroma
– Pes anserine bursitis
– Iliotibial band syndrome
– Patella tendonitis
– Prepatella bursitis
Intraarticular injections
• Steroids
– 10ml 0.5% marcaine
– 80mg Depomedrone
• Viscosupplementation
– Synvisc 1
– Durolane
Steroids
• Help 50 % with arthritic change
• Can take 4-6 wks to have effect
• 5-10 % worse short period of time
• Tiny risk of infection
• Very variable benefit duration
• Not if imminent TKR - ^ risk of infection
• More benefit with effusion
• Very unfit
Viscosupplementation
• Variable outcome
• Grade 1-2 oa changes
• Help 50 -60 %
• Can last up to a year
• Can be painful
• £2-300
Under Patella
Under patella
Arthroscopy portal
Pes anserine bursitisiliotibial band syndrome
• Analgesia
• Rest
• Physio
• Targeted injection
Pre-patella neuroma
• In bursa
• Very sensitive
• Can feel tissue lump/band
• 2ml local and steroid
• ? Immediate effect
Pre-Patella bursitis
• Inflammatory
• Infective
• NSAID/rest/ ? Abs
• Generally don’t inject
• Occaisionally surgery
Patella Tendonitis
• Rest
• Analgesia
• Physiotherapy / U/S
• Shockwave therapy
• Do Not Inject
Questions ?
Recommended