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This books will show you how to make intra-articular injections.
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7/17/2019 Techniques of ITechniques of Intra-Articular Injections and Peri Articular Infiltrationsntra-Articular Injections and Peri Articular Infiltrations
http://slidepdf.com/reader/full/techniques-of-itechniques-of-intra-articular-injections-and-peri-articular 1/22
7/17/2019 Techniques of ITechniques of Intra-Articular Injections and Peri Articular Infiltrationsntra-Articular Injections and Peri Articular Infiltrations
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DIPROFOS'
'l
ml contains:
2
mg
of betamethasone
in
the
form of the
phosphate
+
5
mg of betamethasone
in the form of the
dipropionate
7 mgof betamethasone
EQUIVALENCE
OF
SYSTEMIC
CORTICOSTEROI
DS
(from
GOOD|/AN & GIIMAN'S
'
EIGHTH
EDITION
-CHP.
60,31
-
I
's
=
sHoRT
(biolosicol
hol{'lile
ol
s to
I
2 hours)
|
-
ll..'ltRrrlEDlAlt
lbioloskol
hollli{e ol
I
2
b 36
ho,ll)
|
=
LO|IG
lbiolosiol
holl-lile of 36
b
72
hounl
FA/.s /f*/r"f /sn/r{/f
20 mg 5mg
25 mg
4mg
4mg
2rg
0,75 mg 0,75
mg
53
m9 13 mg 66,5
mg
10,5
mg
10,5 mg
5rg
2rg
2mg
80 mg
20mg 100 mg
l6
mg
16 mg
8rg
3mg
3mg
133 mg
33
mg 166,5
mg 26,5 mg 26,5
mg
13 rng 5rg 5rg
160 mg 40 mg
200
mg
32
mg
32 mg l6
ntg 6mg
619
186,5
mg
46,5
mg
233
mg
37
mg 37
ng
18,5
mg
7ng
7^g
200
mg 50 mg 250 mg
40 mg
40
mg
20
mg
7,5 ng
7,5
nW
ANII
INTIAMMATORY ACIION
tl
0,8
5
5
t0
25
25
SOUUM REIENTION
0,8 0,8
0
0,5 0
0
0
DURAIION' OT ACTION
s
5
t
7/17/2019 Techniques of ITechniques of Intra-Articular Injections and Peri Articular Infiltrationsntra-Articular Injections and Peri Articular Infiltrations
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7/17/2019 Techniques of ITechniques of Intra-Articular Injections and Peri Articular Infiltrationsntra-Articular Injections and Peri Articular Infiltrations
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INJECTIONS
AND INFITTR/NTIONS
OF
THE
KNEE-
Afthough
a
painful
and
pxsibly
swollen
knee will readily
evoke a diagnosis of
inflammatory
infective,
or degenerative
joint
di-
sease, it
should
be
remembered that the
knee
is
a
common
site
of
abafticular or soft
tissue
rheumatic
dinrders of
various
types
because
it
is
prone
to
injuriu
that
may
affect
its tendons, iE
synovial bursae, or
iE
ligaments. This must not be ignored
despite
the
complexity
and
the
variety
of symptoms
presented
by various
clinical
picturu.
.
From
the
preventive
point
of
view
it
is
important
to detect general
disorders
or
static constitutional or
funclional
abnormali-
ties that
could
lead
to degenerative processes
in
the
tr'ssueE
or
recent
traumatic
lesions
which,
however
slighg
could
have the
same consequenc
es
if neglected.
.
From
the curative
point
of
view, an
accurate
clinical
and radiological diagnosis
of
the
chronic
lesion
is
needed in order
to
d*
termine the most appropriate
treatnenL
'Theseinfihrationsmunalwaysbecarriedoliunderrgorouslyasepticconditons.
A
.
MEDIAT ROUTE
Indications
:
very suitable for
joint
cf{usion.
IECHNIQUE
Needle
:50
mm needle
of 8/10 diameter.
Dose
to inject :
1
ml,
Infiltration :patient,
layingon
his backwith knee s lightly flexed.
This
route
is
often
painful
because
of
mechanical rubbing
of the
kneecap.
The
injection site
is
located:
.
in the intercondylopatellar
sulcus midway betrveen
the tip
and he base
of
he ptella. The nedle
is insefied tl a
hth
of 2 cm.
7/17/2019 Techniques of ITechniques of Intra-Articular Injections and Peri Articular Infiltrationsntra-Articular Injections and Peri Articular Infiltrations
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.i
B
-
ANTERIOR ROUTE
Indications
:
osteoarthrjtis
of the knee,
rheumatoid anhritls.
TECHNTQUE
Needle
:
50
mm needle of B/10 diameter.
Dose to inject :
I ml
Infiltration
:
the anleromedia
routc
is
usuallv prel.erred, often
facilitated by slight latefal subluxation oi the
patella. The pa
tient
is
placed in the sitting pos tion rvith the
leg pendent,
or
laying
on
his
back
with the knee flexed
at
about 80".
The
injection
site
is located:
.
1.5
cm
or 2
cm
inside and be
ow
thc apex oi the
patell.t
according to ihe thickness of the
pannicul s
adiposus.
The needle is inserted perpendicu ar to thc skin or at
a
slight
ang
e,
posteriorly and medially.
The
needle
is
insertcd
to
a
depth
oi 2 to 3 cm accofding to
the ihickness of the
pannicuLus
adiposus.
7/17/2019 Techniques of ITechniques of Intra-Articular Injections and Peri Articular Infiltrationsntra-Articular Injections and Peri Articular Infiltrations
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C.
IATERAL
ROUTE
lndications : hydrarthrosis or eiusior.
TECHNIQUE
l'{eedle :50 mm needle
of
B/l0
diameter.
Dose to iniert :
1 ml.
Infikration :the
patient
is
laying
on
his
back
with
the
knee
very
slightly flexed.
Ihe injection
site
is
located:
.
L Suprapatellar injection
(fairly
difficult and painful): ln thc in-
tercondylopatellar sulcus about 1 cm above thc patella, accor-
ding to the thickness
ofthe
panniculus adiposus.
The needie is inserled
to
a
depth oi2 cm.
.
2. Subpatellar injection : in the ntercondylopatellarsulcus,
mid way beh\een the apex and
the
base of the patella.
The needle
is
inserted
to
a
depth of
2
cm.
D
.
POSTERIOR
ROUTE
Ind
icatio ns : popl itea
L
cyst
-
eiiuslon
(monarth
ritls,
osteoarth
ritis).
TECHNTQUE
N
eedle :50 nm
needle of B/10 diametcr.
Dose
to
inject : 1 ml.
Infiltration :lhe patient
is
placed laying
on the abdomen
with
the
knce
slightly
flexed.
The
inieftion
sjte is located :
.
in
the medial
part
of the
pop
iteal space,
just
medial
to the
tendons oithe semimembranosus and
thc
scmllcrdinosus.
.
the needleBrazes the
medla
border
oithe
condyle and
is
pu'
shed doivn to the floor oithc pop ileal space
.
the
needle
is
irserted to
a depth
ofabout2 cm perpendicular
to
the skin Check lhat no
blood
runs back
through the
necdle
as
thcrc
is
,r
risk of puncluring
lhe
popliteal
vein or arlery
(aneurysm).
,,...-..'.-.--.--
ry:-L
I
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INJECTIONSAND
INFIUTR/ATIONS
OFTHE
SHOULDER
Soft
tissue rheumatism
:
"This
most
commonly
takes
the
form
of local
symptoms
which can
be
app.reciably
or
completely
re-
lieved
by
tocat
injection.
However
this
simple
procedure
mustbe carefully
thought
out and
carried
out
safely
and
with
the
ut-
most care
: it
should
not
be
a
reflex
ruponseio
all
localised
disorders
carried
out
indiscriminately,
without
technical
know-
ledge, and
anywhere,
in
a
place that
is
not
pefectly
clean
or
on
the sports
field..Local
infiltrations
must
only
be
adiinktered
by
qualified
peisonnel
under
rigorously
aseptic
conditions;
to ignore
this
rule
is
to
expose
the
patient
to the
risk
of
local or
perhaps even
general
infection."
Professor
A.M.
RECORDIER
1.
lrrfiltrqtion
of
rhe
qcromioclqviculqr
ioinr
Ind
itations
:sequelae
of
acromioclavicular
dislocation
or sprain,
acromioclavicular osteoarthritis.
Needle
:25
mm
needle of 5/10
diamcter
with
long bevel
Dose to
inje(t:
1/2 ml.
.lnfiltration
:the
patient
is placed
in
the
sitting
position
Ihe injettion
site
is located:
'in
the acromioclavicular
joint
space
: this
joint
space
is
easily
identified
if
the
ioint
js
dislocated
or
affected
by
osteoarthritis.
Thc infiltration
is
made
into this
joint
space
with
the
needle
inscrtcd
obliquely
downwards
and
medially.
The needle
must
not be
inserted to a depth
of
morethan
1
cm.
I
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,.,1.
lndications :
frrzcn shouklt'r. r,r;rsrr
tis,
rhrunt,ttocl
rrlhrits,
ll0st
tr,t nr.rl
(
l)
(x
k.
f, tcdlt:
l5
nll
,ltr:l
;'10
rli,lrrtf r)
a(l
nrnt
an,:l
11,10
tlimcicr
ntd
r,,r
r
oril n
1(
)
lx,lh
fl(x,i5
(
)l
thr
lt,tnnrr
uhs
adl-
P0s i.
Dlsc io injert
:
nt
rliltratior:lhcpalicntirlr,uul
I
tlrt:ift
ng
|Lrsition
u tth
lrnr
,rhd cl.d
,ri
l;'. The
nleLtLon sttr :
IrL,rlrr1
.
nttrfll
,ll(,
\
lloste
iLrl
to
thf .,1(
rottr
or
l,tl'ir
Lr
,rr
1o
nl.
.
,rl lhe .rpf\ oi thL' ,rr lle
,,rU
e
ionl(l l)\
thr,
Posler
or
boxler
'i
l'
1.''
l.
''.r
l'.,f
.
'.'
'r'r
'r
lhr: lt't
rl[' r
ifselleL]
,lt ln .r0'l
r,, ilotnrr,rrds ,lr1
slighl
v
,rler,r l\
(lo\
n
k) t
rc r.ll1
l.r
1'
(t
thi
hf,rtl
d
tht'
hlnx'r us.
.
.1,,
:|
ii
i,rl
"''
w:
."I
\
I
j;qllr,ris1'1
lt,t)r(,n
5ll)Lt
tlli
ri\|l ,lto
(ln
lltfili
,trrf/ri,I r\rr ,
"'
ii\
''lrr:Lllt .l;
f
Ir,Ix1li,1i[]
(lix|rt0
{rr
5[)nnlr
ar](l
11/l0al
antctcr
rmclr,rr
r orrl
nq Lr-r llte Lltrr
'rtcss
ot lltr
p,rilt
tt
us,tdiposls.
l-lo c
lrr Ujr[l . I m.
'r'liiL:.rtr5.
:
lhf
iIlttittis
p,rrrr I llrIsill nqlx)s to| \\'
ill
llrl
srou tlcr
s
,qhl
\
lit('r,r
r
fr)l,rlffl.
Thf
ini('ctio
r s
l|
s
(x alr'fl
:
.
I
(_nt
,rl)r)\f
thf,tcfont
|( ,r\'r | ,r
Jt)|rl.
f lrt
neer Jle
.
ilscrlccl,rl,r
il
qlrt
rI
ru
rl,,,rri
l,tng
c
unt
l l clnltcs
rlr r
L rrrrl,u I ri
itlr the
he,rrl
or
iltt hLrnl,rus
{
t
I
t
I
I
\l
I
I
,
t
I
I
I
l
I
I
I
I
I
t
I
7/17/2019 Techniques of ITechniques of Intra-Articular Injections and Peri Articular Infiltrationsntra-Articular Injections and Peri Articular Infiltrations
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r'
iilIp|d:'lt]]ffidlll
frlr{:11}rt]J'll
i ;l
Indications:
frozen shoulder
(all
qvpes),
capsulitis,
fhcumak)id arthrltis.
Needle
:
25
mm
needle of
5110
dhmeter with
a shod
bevel.
Dose to
inje(t
:
I
ml.
lnfiltration :
thc
paticnt
s
plaled
1n
thc
sining position
with
lhe
f nr.
i hllr,rbdu(1rrl l{)
i.
The
iniection
sit€ is
located
:
o
rt lh.
f[,r5r'.iion
l]{rlrr'eer
a
pcrpcndlcular line2
cm
mcdial
to
ihe
ateral
lnrdcr of
the
acronlon
and
a horizonta
line2
cm
belorv the
in1.er
or
horclerofthe
lateral
part
oithe
acromion.
The need
e s
inserted
pcrpendlcular
to th-"
skin
until
it comes
iftii
contact
$'ith
the
head of the humerus.
,'i.,i'lir;';-iril i,ir,il,. ili{i::fll li
ii'il;
Indications :
irozen shou
cler.
Needle :
15
nrm
reed
e
r-rf5/10
diameter.
Dose
ro inject :
I
ml.
lniiltration :thc
paticnt is
placed
jf
the
sllling
positi0n
$'Lth arrn
pefdent.
.
1
cm
beloi,,;
thc
nlcrior
lnrcler
oi
the
acrr)rrion
on the
lalern
.rspccl
oi
thc shoulder
{s
ightlv posterior
y).
Ilrc needlc
is
lnserLed
at a
slight anglc, upwards
ancl antetiot
y,
l)etweef
the
great
t berositv
oi thc
humerus ard
the
intcfior
aspeci ot the a[nm]of .
ffi
-
|
{r4
ir
:ir
ri'r
;l
i
}
t;l
I
j\l
[.i
lljliili_iliii
[
1.ili]d|,,]}
::liF
fF'll[i],;,lii1ii,:il'iilril;1.:l;
d0ltrldltis
detded
l)t
palpation, alicr the patlentcom
pla
ns
oispont,rncous pa
n
on alrdLrction
ofthc anr
be),ond
45').
2l
mm needlc
oi
5i l0 dlanre'tir.
I ml.
tl
e
prtient
rs
placecl
in
thc
silting
pos tlon
W
th
afm
pen(1Lilt.
\liNlrr opp(,s
(r(
to,rbdr(llof
0ilhcamrircilltates
iderntficationoi
lhl
r
orvlrglnr
l oi
thc iibfcs oi the delkrid
musr
e towads
thc
r Iito rl\, lrlwtu
lhc
b ccps
alrt$ior),
rnd
thc trircl]s posterlnl]'.
Irl
rrrrlr''
irr:r'
lcti,rl
lhispo
rtperpendiculartothe5l(if
Lrrrtil
It(1)r)ir,\nlorrlrl,r(1
$'ilhlhcbonealadepth0il,
to I cnr.
'/-
ti,--
I
t
I
I
I
I
I
tl
ll
/
I
lr
I
\
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I
NJECTIONS
AN
D
INFI
TTRATIONS
OFTHE
ELBOW
Dr.
F. Comrnandrc
The elbow is
the
maior
site
of soft
tissue
rheumatic
disease.
Many
forms
of inflammation of
aftachment of
muscle
or ligament to bone or dinrders
of the
muscle
insertions can affect
the
elbow
(C.
la
Cava). Epicondylitis is
the
predominant form
of tendon
disease,
but
bursitis
and nerve
compression syndromes
are also
observed.
The
suruey carried outby
J.
Cenety
(1975)
indicated
the
relative incidences
of
disorders
at this site:
epicondylitis
66%
dinrders
of the
headofradius 20%
epitrochleaitis 9%
olecranon
pain
2%
misc.
bone
disorders
the radial
insertion
of biceps
medial humeral radial
tunnel syndrome
(i
nterosseus
nerve) about
2%
1%
1%
A.
TAIERAT ROUTE
Indications :Tennis elbow
or
Eicondylitis,
epicondylalgi4
sprairy
pulled ligamenr
TECHNIQUE
l{eedle
:25
mm needle
of5/10
diameter.
Dose to inject :
1
ml.
Infiltration :
the pain
can be
located
by opposing movement of
the
wrist
and
fin8e6
with the elbow flexed
at
90' and the
hand
supinated.
a. epicondylitis
-
epicondylalgia
The injection is made into
the site
ofthe
pain
:
.
either by
a
fanning movement
of
the needle in order to distri-
bute
the liquid without
excessive
increase
of
prcsure
at the site
(butthere
is a
risk ofcausing further
damage to the musculoten-
dinous tissues),
.
or at a single point,
with
fairly deep insertion
ofthe
needle
until
it
comes into contact with the
periosteum.
b.
sprain
-
pulled
ligament
(radial
collateral ligament)
The injection
site is located
just
above the
epicondylg
mid
way
between
this and the lateral aspect of the
olecranon,
and
the
injection
is made at an angle,
pinting
upwards, slightly anteriorly
and medially.
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B.ANIERIOR
AND
MEDIAT
ROT,IE
a Indications: osteoarthritis
of the
elbow,
involvement
of
elbow in rheumatoid
arthritis,
diseaseofthe
head
ofthe radius,
painful
supination
in
the adult. Intra-articular
injection.
TECHNIQUE
Needle :25 mm and 5/10
diameteror 50 mm and
B/10
diameter
needle with
short
bevel.
Dose
to
inject
:
I ml.
Infilnation:
with
the elbow
extended, the
injection
site
is
l.cated
along
the distal
part
olthe
lateral margin ofthe
tendon
ofthe
biceps.
The needle is
inserted
perpendicular
to the skin
until it is felt
to encounter
the bone
of
the
head
ofthe
radius.
b.
Indiation :
inflammation
of
the
teodon
of
the biceps.
TECHNIQUE
l,leedle
:
25 mm needle
of 5l10 diameter.
Dose
to
inject
:
1
rnl.
Infihration
:with
the
elbow flexed
at90',
thetendon
standsout
on supination
of the hanrj.
The
needle
is
inserted parallel
to
the tendon
alon8
its
lateral
sudace untjl
it
makes contact with
bone.
c. Indication
:
Colfers
elbor:, or medical
humeral epicondylitis
anle'rrr
and ncdial
route.
TECHNIQUE
Needle
:25
mm needle
of5/10
diameter.
Dose
to inject :
1
nrl.
Infiltration
:
the site of pain rs
identified
by
palpation
with the
elbow flexed
at90'.
The
injection is
made
into$issiteof muscle
pain,
the needlebeing
insertd
until itencountersthe
periosteum.
This
ensures
that the needle
remains clear
ofthe
ulnar
nerve
in
the sulcusformed
by
the
medial epicondyle
of the humerus
and
the
olecranon.
d-
Indication:
infiltration
of the ulnar collateral ligament.
TECHNIQUE
Needle
:25
mm nccdle
of5/10
diameter.
Dose
to
inject
:
1 ml.
Infiltration :
great
care
is
needed
here because
of the
proximi-
.
ty
oi
the ulnar
nerve
on the posterior
aspect
0fthe medial
epi-
condylc
of
$c
humerus. The
elbow
is
flexed at
90'.
The injec-
tion sitc is locikd
directly
anterior to and slightly inferior
to
the
tip oithc rnediai
epicondyle
ofthe
humerus. The infiltration
is
mad('between
the skin
and the
surface
ofthe ligament.
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C.
POSTERIOR
AND IATERAT
ROUTE
Indications:
tendonitis
and bursitis
ofthe
triceps,
hygromas
of the
elbow.
TECHNtQUt
Needle:25 mn
needle
oi
srlg6;rr.,.r.
Dose
to
injert
:
1 ml,
Infiltration :ivith
the elbow
extended
a nd
the
triceDs
tensed,
the
sites
ofpain
are located
by palpation
aboveand
alongthesides
ofthe
olecranon.
Ihe
injection
site
is
located:
a.
for
tricipital
tendon
rtis
: arou
nd
the
sites
of
pain,
avoiding the
lendon.
b.
for
tricipital
bursitis
: with
the elbow
flexed
at 90'
identili),
the
epicondyle and olecranon. The injection
s'te
is
located beneath
theepicondyle.
The needle
is
inserted
perpendicular
tothe
skin,
pointing
downwards,
posteriorly
and medially.
c.
avoid
infiltration
for
hygrcmas
of thc
elbow. li this
is
not
possible,
asthe
hygroma
is
essentialiy
subcutaneous,
inject
l ml
directly
beneath
the
skin.
D. POSTEROIATERAI
ROUTE
Indications
:
disorders affecting the
head
of the
r
adius
(epicon-
-
dylalgia),
osteoarthritis
of
the
elbow,
involvement
of the
elbow
in rheumatoid
monarthritis
0roJigoarthritis.
TECHNIQUE
Needle
:25
mm
needle
of5/10
di;meter.
Dose
to
inject
:
1
ml.
Infiltration
:
the
elbow is
flexed
at
about
90'.
The
injection
is
made
intothe
radio-ulnarsulcus
perpendicu
lar to
the
skin,
i
cm
beneath
and anterior
to
the inferior
border of
the
epicondyle.
The needlc
is
inserted
1.5
to 2
cm
into
the superior
radio-ulnar
joint
c.rpsule.
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B.WRISTJOINT
lltliraiions
:
sequelae of injUry
(sprain,
injury
to the
wristor wrist
joint),
synovitis, rheumatoid
anhritis.
Osteoafthritis
ofthe wrist
(very
rare).
TECHNIQUE
,nli.edle
:
25 mm
needle
o{ 5/10
diameter.
oJ I to iiiioci : l/2 to I ml.
liiirlurticii :the
wristjointspace
is identified through the skin on
the dorsal aspect
ofthe wrist, with the hand pronated and
resting
on
a
table
or
hard
surlace.
e.
stylold process
of
radius
A compressible region, which is
ollen swollen
(acute
0r
chronjc
inflammation) is usually readily identified by touch, behveen the
distalextremity oithe
radius, the lunate and
thescaphoid
bones.
The
lnjection
is
nrade about 2
cm
(one
finger's
width)
from
the
styloid
proces
ofthe ulna.
The needle is inserled perpendicular
to the skin and then ang ed upwards with the hand kept
pronate
lo opcn
the
joint.
f,gi..il]0F.I :care nrust be taken to avoid the veins in the dorsal
side of the
wrist
and the
hand. Painful reactions
are
fairly
com-
mon because
ofthe
distension
ofthe
joint
capsule
lthe
injected
amoift
plays a
part
here).
[.
st,vloid
proccss of the
ulna
Same principlc, but
in
this instancethe injection
is
nude
bt'l^/een
thc distal extrcmiry ofthc ulna
and
thc
triquetral
bone.
C
.
DISTAL
RADIO.UTNAR
JOINT
,,r1{ri olrs :
osteoaft
hritis,
sprain.
TECHNIQUE
fifldjr
:25
mm needle of 5/10 diameter.
l:e rr; rnlcri :
1
ml.
rliriir:iilr
: the hand is p aced
flaton
a hard surface.
After locating
the base
of the stvloid
process
of the ulna
and the
radius, the injection is made about 2 crn irom the border of
thc
ulna. The need e is inserted perperdicular to the skrn.
4
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D
-
CARPOMFTACARPAT
JOIT{TOFffETTIUMB
Indications
:
osteoarthritis
oithe
base
oithe
thumb,
lr,ery
rarely)post-
traumatic sequelae
LspIa
n, dis
ocation...).
TECHN
QUE
Needle
:25
mm
needleoi5/10
diarneter
Dose
ro inlcct
:
li2
to
1 mL.
Infrllration:
the
iirsllretacarpaibasc
is ocated
on
thcback ofthe
hand. The osteo-articu
ar intersection
formed bv
the
fint
and se-
cond
mchcarpal
bones and
the
napezium
is then
identiiied
by pal
pation,
ivhich
s
oiten
painfLrl.
The
n1,"cl0n is made
Frpendlcu
arto
the skin,
graz ng the atera
J
border
oi the
i r(
nreLicarpa
L
The
necdle
passes
lleh{een
the lrapezlLrm and
the heads
ofthc
first ard second
metacarpals. The
injcction s
olten
palniul.
ffi
',"
fffi ETACARPOPHAJhNGEAT
AI{D
II{TERFT{A,TANGEAI-
JOINTS
lnditations :
osteoarthr
tis
oithe
fingers;
metacapophalargeal
i0ints
irare)
and
distJl
interPhaLafgeal
]oirrts
: I
ieberden's
nodes;
proximal
intcrphaLangeaL
joinls
:
Bouchdrd's
nodes,
iheuma
toid
arthritls,
l)osftraunratic
seqlelae.
IECHNIQUE
N
eed
le
:
15
nnr
needlc ot
5/
l0
diameter.
Dose
ro
injeri :
l/l
ml.
Infiltration :
the
iniection
is nrade
irto lhe
joint
spare
or
the
dorsal sidc
of the finger, to the
side oi
thc cxtcnsor
tendon
ilate
ral
y
r-rr
nrcdiallvlgrazingthc
mctacarpalor
phalangeal head.
fhe
necdle s lnserted
at an
angletowards
the d
stalextrcmitles
oithe
fingen.
Thls
injection
is i,ery pa
niul.
Cryoanaesthesia
($,ilh
cryo
iluorane)
is
rcconrnrendecl.
f iff4: flffith,fi",
ll]h[AlAl{GFAt
pADS
lndications :
lrr
ht
of, fllanrmat
of,
bursitls.
TICHNIQUE
Needle
:
2i
mnr nced
e oi
5/10
dianreler or
vcry
f
ne
and short
intradcflrir
need r.
Do5t
to
inj3ct
:
lll
ntl.
lrfiitration
: lhc prds aie on the dorsal
irce
c-ri
the proxinral
irtcrphrhngr',rl
loinls
Ihe.v are oi
soitcr consistencv
than
lirLr lr,rrrl's rrr xlcs, irrlr
wh ch
thev
should
be
distinguishcd.
The
in
jt'r
t
r
n
s
rr,rr['
l,rteralLr',,rl thc base
oi thc
pad, n
ihe
region
of
lr'
;.
,.rr
r.r
'
.r'l
;.
|
.
.
il
t
"l
7
I
f
.-'.;--:,'.'::,
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2.
Lqlerol
ospecf
A
.
SIYIOD
rc(ESOFIHE
MDII'S
Indi(ations
:
radial
styloiditis,
TECHNIQUE
Needle
:25
mm
needle
of5/10
diameter.
Dose
to inje(t:12
to
1
ml.
Infiltration
:
identify
the contour
ofthe
styloid process
ofthe
radius
on the lateralaspect
ofthe hand;
jt
is
painfulto
pressure
dnd_somerimes
shows
signs
of inflammarory
sweljilg.
siloiditjs
is
otlen
dsso(iated
with
inflammation
ofthe
lendon
ofthe
lorg
fleror
oflhethumb
or De
Quervain
s
lenosynovrtis.
The
injeaioi
rs
made
dtrertly
againsl the
bone where
rhe
pain
is
localised.
B
.
TENDON
SHEAI}IS
OF
ME
TONGABDUOORANDTHE
SHORT
DfiENSOR
OF THE
THUMB
Indications
: De
Quervain's
tenosynovitis.
TECHNIQUE
Needle
:25
mm
needle
of5/10
diameter.
Dose
to inject:
1/2
ml.
In[iltlation
:it
is
essential
to recognise
the outline
of the anato-
mical
snuffbox
:
r
anteriorly
it
is
bounded
by the
tendons
of the
abductor polli_
cis longus
and the
extensor pollicis
brevis in
their
common
synovialsheath;
in
cases
ofabarticular
inflammation
there
is
:
.
swelling
with
or without
crepitation
on palpation
and
on
active
movement
of the
thumb,
.
orsimply
stenosis
and pain,
.
posteiiorly
the snullbox
is lmunded
by the
extensor pol)icis
longus,
.
and its
base is
formed
by
the styloid proces
of the radius
ind
the
scaphoid.
It
js
important
not
to forget
that the radialartery
and
is
branches
pass
through
the
distal
part
of the
anatomical
snufibox.
The injection
is made
into
the lateralface
of the
wrist
and hand
at the
tip
ofthe
styloid process
of the radius,
the needle
being
angled
upwards
in
order
to
pas
into
the synovialsheath.
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3. Pclmqr
A.
CARPAITI., f{NEI.
cr
rP,r I
tun
ne
svnd
ranre,
reiracklry acfoparrcslhesia.
TECH\QUE
li mnr nccdle oi ir'l0
diamctc'r.
tnt.
the
hnnd
Jfd wf
(
are exam
nfd
n
the
r,rnter
or or
n
ll
,l
.l
n,
Ln
r'
tt
.l
l
r
"
t.n.i,
. ln,
.,t'
:
.
c ther the aftefiof llrberclc oi thc scaphoicl,
.
ot the second I
errrc
inc on
thc skln
frorn
the palnt on
lhc
dfter/or ispccl
ot
ilre
wrlsl,
.
orthcs(rlo
d
process
oithe radius.
Ihrtc nr(,tlrods
oi irjertion ma
lr
usccl
:
re alive
to thc Jnterior tulrrclc oi trc
scapho d.
Alons;r
horizontal fc I()m
lhe
ffter or tLrbefc c to
thc
pisr-
tonr
bone,
thc injelion
is macle
one i n,ter's lviclth nrcdhl
to the
tul)ercie, rnal
just
fredial
to
the
palmlr s longus rvhrah Iorms
one
sidcoilhechanne
ior the r,rclhl artcn,. Tho
need e
is
nserted al
.rn angLc
po
nt
ng
cloivnu,ads,
nx,dh
ly
and postcfloriv to\\,ar[]s
lhc
ilrrs{'r5,
ti).r d0pth oi I i to 2
cnr.
relat l,e to
thr
mcili,rl
flexlre line on
the
anlerior
sud.tce of
the \\,ri\1.
Th-" inje,ctiirn
is
nrarlt,nt-"diit Iothc lnterse(lol oithisilt'rrrrc
line
.rnrlthepalnraris
brtvis Theneedle s angkrlvet
shar'p v doivn
rurrrh, redlal
,,
and posteriorlv tovr.rrcls thc
tingcr
in
ofilef to
J\roi.lihf
nrrcliar
f0r c. lt
js
ijtcedcd to
i
depth oi
l.;
k) 2
(jm.
ft. .r1 \,(' lo
tlrc
.pe\ oilhe
stv o d p
ocess
ol the
fadius.
llrf
nif(tlon i
m,tdr.J to,1 mn p()rim,rl
totheaperoithc
slr
o
11
prori,ss
oi thc r,rdius, in
lhe su cus iornted Lry thc
tcrdons oi thc palnr,rris ongus
rnd
the palnr,rris hrcvis. I he
reecl
e
is nscrtc,cl
,rt ,rn lnqle, ntccliallv. rllrnwarrls
lncl
po(crior
\'.
N.fl.
:
\('l'or
cls onallv lhe rccd
c
prnft res
the med
af
r(' t'
a.ru5
r1t sharp
pl
r
i
this slrould hrppen
do
nol
Irrxr&
u th thc injeLt
or
L)ui
mo\c thc fccdlo lo,tnotlter
l)o
lior.
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B. UTNAR
NERVE COMPRESSION
I
.irit
l:r
ulnar
nerve
compression.
TECHNIQUE
li mm
needleol
5/
uoramelcr.
l/2
to
1
ml.
,
"
identiry the
plsitbrm
bone,
the
tendon
ofthe
flexor
carpi ulnaris and
lts
insertion.
The
lnjection
is
made
at a sharp
angle later;1ly to the
tendon
of
the
flexor
carpi
ulnaris, clownwards
and slightlv
posteriorly.
The needle
is inserted
to
a
depth
of 1.5
cm.
lf the
ulnar
nerveorthe ulnarartery
is accidentally
punctured
do
not proceed rvith the
lnjcction but
move the
needle to another
posilron.
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C.
TRIGGER
FINGER
Indications
:
tenosynovitis
of the flexor
muscles
of the
finger.
"Trigger
finger".
TECHNIQUE
Needle :25
mm
needle
of5/j0 diameter.
D
ose
to inje(r :
1/2
to'l ml.
Infilnation
:
the nodule
on
the tendon
of the flexor
is
detected
by
palpatiOn,
lsually
in front
of the metacarpophalangealjoint,
and
on
active movement
ofthe finger.
The finger
is
very
slightly
flexed.
The
needle is
inserled
opposite
the metacarpophalangeal joint
at a sharp
angle, posteriorly
and downwards
until it reaches
the nodule to be infiltrated.
D
.
DUPUYTREN'S
CONTRACTURE
Indicatioul
:
lLtpgytrgn's
contracture.
TECHNIQUE
lleedle
:25
mm
needle
of 5/i 0 dianreter.
0ose
io irle(t
.l/2
to
I ml.
infii
ra ti0
n
:
pa
lpation reveals
the
aponeurotic
bands
and nodu les
oi
i
e'0'elr.rL
'ile
paln
dr
aponeuro'irrs
DupLrl
tren s direa.er.
The injection
is made
into the
nodules and
bands. lt is
often
difficult
and painful.
Aponeurotomy
has
rendered
this treatment
ress
useruL.
The injection
must
be followed
by
vigorous
but controlled
extension
of
the
retracted
fingers.
s".
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DIPROFOS-
lbtomet|oonediorooionole
ond betqmeAoone
disodium
phosphote)
indtot nr,
doroq"
dnd
odtinirhclion
:
DIPcOFOS
i5
rcco.nmended
b
{
I
I
nno-uscl o'
r
edior
ir
oolierh
rcourng
rv:temic
co-icovet
d
{eropv
l2l
dreo
rni*tion
iro
$e
ollectd soh
fitsues,
{3)
ilro-
or pef-or'cJlor
inlec
or
lo' lhp
reot
r""
"i"it,
'i.,
faf
ai'*i
'ii"i'ion
ro
J i. bsio"s: ond
(5)
ocol odmiristrot
or
lor the
treo-enl ol
vorious
cvslic
ord
,nllommotor diorderr
of the
fooi
l.
5dt
tirsue ond
mus(ubrl&toldircrder: Rheumotoid
odhritis,
osteoodhritis,
bursitis,
onkylosing
spon-
dvlitis, epicondylitis,
rodiculiiis, coccydynio.
lorlicollis, sciotico
lumbogo, gonglion
cysf, e-xosirsis,
fosciiris.
'Dosoqe
'
I
o
2 ml by deep
lM
iriec'on.
'ntro-orticulor
nieo,or
0 25
n
2 mi
ctording
b
he size
ol he orl
2. Alkok diroid"" Ch'ont bronchiil
os'h.o
linciudinq
odi,rnctive
theropv
for
stottrs
osrhmoticus),
ho' feJer. onoioneurotic
edemo,
ollerqic
bronchitis,
seo-sonol
o'
perenniol
olle'gic
rhinilis drug
reoc-
rions.
serum
ilckness,
insea b;res.
llo hnefic
olos
odincnil|eropy
n slotus or*rmoticLrs.
Dosoge:
I
lo 2
mlby
deep lM
iniecflon.
i. ili"
a;tl"t",
ar"oi. a"rrnoliis
lnvmmuloreczemo),
neurodermotiiis
(circumscribed
lichen simplex),
necrobiosis
liooidico dioheticorum,
olopecio oreolo,
discoid
lupr-rs ery*'emotosr,'s,
psoriosir,
keloids,
oemohiqus
dermotitis
heroetibrmis
uricorio,
\ypertrophic
lic\en
Plonus,
conlocl
dermofiris,
seve'
i" iJf"r"a"ir"riti.,
"r'f.
ocne
Dosoge o
? ml by deep
lr'r irir on
Di'ecl
rrrooeric
ir
iec
or
irb
Ae
les
on
of 0 2 ml/cm?
uo to
o moximum
of
I
ml
per
week.
l, ia.g""
ai*"
Disseminoted
lupus
eryhemol,cs,-rs,
sclerodermo, dermotomyosilis,
Polyorleriis
no-
doso. Dosaoe:lb?m
bv deep
Mlnleclion
i.
otlriil;"tu"r,ti;;""irol
syndrome,
ulceroiive
colitis, regionol
ileitis, sprue,
podiotric
condi-
t'ons
{bursilis
under
helo#o durum,
hollux
'igidus,
digiti
quinlivorus)
drsorden
requiring
subcon
i*.i,i.i
i"i*ri.".
-'ri.osteroid
responsiuellood
dv"scrosios
nephri[s ond
nep\rolic
syndrome
brimorv o,
'econdorv
cdrenocortitol
ins,,fficiencv
nov be
treoted
with
DIPROI-OS
Sterile
Aqueous
Susoeision
bur should
be s,.,pple'nenhd
wi$ r'rinerclocorticords
Dooge
b
2 ml bv deep
M
n
ector
'
Lcro]ry
0.25 o
-l
odm
.
st'eo
oy
ruhrcul'n syr nge
'l'e
do'oqe
m,rsl
& b
lo€d b
fie
ooierf5
dridLol lE'rierenrs,
$"
,.',e,
1
ol{e
d oroe,.
{" ,"pne
ono
{e po[irr
s oo lirv
i
olerole
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7/17/2019 Techniques of ITechniques of Intra-Articular Injections and Peri Articular Infiltrationsntra-Articular Injections and Peri Articular Infiltrations
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PAINLESS
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OF CORTISONE
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