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Flashcards in Injections Deck (40)
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1

Indications for Injections

Osteoarthritis
Rheumatoid arthritis
Gouty Arthritis
Synovitis
Bursitis
Tendonitis
Muscle trigger points
Carpal tunnel syndrome
Wound anesthesia

2

Describe Local Infiltration

Injecting into the subcutaneous tissue of open wounds

3

How to clean & sterilize the wound?

Clean it enough
Perform injection
Scrub the skin

4

What medication decreases blood loss?

Epinephrine

5

Describe a Field Block

Inject a diamond around the wound

6

How does one perform a field block?

Skin prep
Inject slowly while advancing the needle
Pull needle almost out and switch directions
Repeat on other side

7

How to Perform a Digital Block

Start dorsally
Go down proximal phalynx

8

Caution with Digital Blocks

Use of epinephrine

9

Indication for Trigger Point Injections

Inflamed tendon or bursa by a bony prominence

10

What ortho issue has pain with resisted wrist dorsiflexion?

Tennis elbow
Lateral epicondylitis

11

What ortho issue has pain with stretching of the lateral side of hip?

Greater trochanteric bursitis

12

What is ischial tuberosity bursitis due to?

Prolonged sitting

13

What ortho issue has pain with resisted flexion?

Ischial tuberosity bursitis

14

Aftercare for an Injection

Rest
Ice
Anti-inflammatories
Resume conservative stretching

15

Why inject joints?

Inflammation

16

Inflammatory Conditions that Benefit from Injections

DJD
Bursitis
Tendonitis

17

How does corticosteroid injections help decrease inflammatory reactions?

Limit capillary dilatation
Vascular permeability

18

Risks of Joint Injections

Infections in healthy patients
Soft tissue inflammation
Acceleration of a septic joint
SubQ atrophy & skin depigmentation
Steroid flare
Exacerbation of Dm
Cartilage damage
Tendon rupture
Allergic reaction
Anaphylactic reaction

19

Describe a Steroid Flare

Facial flushing
First 24-48 hours
Clears in 1-2 days

20

Contraindications for Injections

Adjacent osteomyelitis
Evidence of bacteremia or febrile illness
Hemarthrosis
Impending joint replacement (days)
Infectious arthritis
Joint prosthesis
Osteochondral fracture
Periarticular cellullitis/severe dermatitis/soft tissue infection
Poorly controlled DM
Uncontrolled bleeding disorder or coagulopathy
Clotting disorder & anticoagulation
Broken skin or cellulitis over injection site
Joint infection
Immunosuppressed patients

21

When to inject with caution?

Charcot joint
Tumor
Neurogenic disease
Active infections
Hypothyroidism
Bleeding dyscrasias
DM

22

Things to Include with Informed Consent

Risks
Benefits
Expectations

23

Risks of Injections

Infection
Bleeding
Allergic reaction
Pain

24

Benefits of Injection

Simple office procedure

25

Expectations from an Injection

+/- help or only for a few months
Increased pain for a day or two after injection
May take several days to take effect

26

Why are deep local injections not recommended for anesthesia?

May enter joint space
May alter synovial fluid analysis

27

Short Acting Steroid Preparations

Hydrocortisone
Prenisolone

28

Long-Acting Steroid Preparations

Kenalog
Aristospan
Depo-Medrol (methylprenisolone)
Decadron
Trimcinolone acetonide

29

Combination Steroid Preparation

Celestone Soluspan

30

How do you know when you are in the joint capsule?

You will feel a pop