CONCISE REVIEW FOR CLINICIANSMusculoskeletal Injection
Section snippets
PHARMACOTHERAPY
Musculoskeletal injections typically involve a combination of local anesthetics, which provide immediate analgesia and confirmation of accurate injection placement, and corticosteroids, which provide prolonged analgesia. The main corticosteroids used in the United States for joint and soft tissue injection are betamethasone sodium phosphate/acetate (Celestone Soluspan, Schering-Plough, Kenilworth, NJ), methylprednisolone (Depo-Medrol, Upjohn, Kalamazoo, MI), triamcinolone acetonide (Kenalog,
GENERAL METHOD FOR MUSCULOSKELETAL INJECTION
Musculoskeletal injections are safe and comfortable with the use of proper technique. Adverse affects from the medications used in joint injection are rare. Intra-articular corticosteroid injections do not lead to the progression of osteoarthritis.20 Postinjection inflammation is caused by intra-articular injection of corticosteroid crystals and can mimic septic arthritis21; however, septic arthritis usually occurs later than postinjection inflammation and the findings are more persistent.
Knee Joint
Knee pain is a common presenting symptom in primary care practice. Main indications for intra-articular knee injection are osteoarthritis, Baker cyst, and pes anserine bursitis.
Osteoarthritis is a slow and progressive disease that is linked to obesity and most commonly affects the medial compartment and patellofemoral joint; however, patients often describe diffuse knee pain. Although patients may report morning stiffness, it lasts only minutes. Furthermore, the pain typically worsens with
CONCLUSION
Musculoskeletal problems are common in primary care and often respond to injections containing both corticosteroids and short-acting anesthetics. Patients frequently present with symptoms involving the shoulder, trochanteric bursa, and knee. Evidence generally supports corticosteroid injection for these anatomic locations. The risks associated with joint injection are very low with proper injection technique and in appropriately selected patients. Experience with joint injection and the
CME Questions About Musculoskeletal Injection
- 1.
Which one of the following injectable corticosteroid preparations has the longest duration of action?
- a.
Methylprednisolone
- b.
Triamcinolone hexacetonide
- c.
Betamethasone sodium phosphate/acetate
- d.
Triamcinolone acetonide
- e.
Bupivacaine
- a.
- 2.
Toward which one of the following anatomic landmarks should the needle be directed when performing a glenohumeral joint injection?
- a.
Coracoid process
- b.
Acromion process
- c.
Spine of the scapula
- d.
Acromioclavicular joint
- e.
Sternoclavicular joint
- a.
- 3.
To prevent which one of the following
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Current evidence and practical knowledge for ultrasound-guided procedures in rheumatology: Joint aspiration, injection, and other applications
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2019, Seminars in RoentgenologyCitation Excerpt :Nevertheless, patients are instructed to call if the localized pain persists beyond this time period or there is local erythema or purulent discharge coupled fever, chills, or other systemic infectious indicators. However, the overall risk of septic arthritis is exceedingly low (<0.3%)1 and this should be enumerated to the patient so as to not cause excessive concern. Diabetic patients undergoing intra-articular or intrabursal administration of corticosteroid may experience transient elevation of blood glucose levels due to systemic absorption.7
Musculoskeletal Corticosteroid Administration: Current Concepts
2019, Canadian Association of Radiologists JournalSeptic arthritis due to oral streptococci following intra-articular injection: A case series
2018, American Journal of Infection ControlThe Challenges of Teaching Ambulatory Internal Medicine: Faculty Recruitment, Retention, and Development: An AAIM/SGIM Position Paper
2017, American Journal of Medicine