Musculoskeletal Injection Procedures...Musculoskeletal Injection Procedures April 16, 2011...
Transcript of Musculoskeletal Injection Procedures...Musculoskeletal Injection Procedures April 16, 2011...
Musculoskeletal Injection Procedures April 16, 2011 3:30-5:00pm
This is the property of Andrew Cooperman, M.D. and should not be copied or otherwise used without express written permission of the author. 1
Musculoskeletal Injection Musculoskeletal Injection ProceduresProcedures
Andrew E. Cooperman, MDAndrew E. Cooperman, MD
Center for Diagnostic ImagingCenter for Diagnostic Imaging
Musculoskeletal Injection Musculoskeletal Injection ProceduresProcedures
ArthrographyArthrography–– MR, CT, Conventional (Radiographic)MR, CT, Conventional (Radiographic)
TherapeuticTherapeuticC ti t idC ti t id–– CorticosteroidsCorticosteroids
Kenalog (Triamcinolone)Kenalog (Triamcinolone)
DepoDepo--Medrol (Methylprednisolone)Medrol (Methylprednisolone)
–– Local AnestheticsLocal AnestheticsMarcaine (Bupivacaine)Marcaine (Bupivacaine)
Xylocaine (Lidocaine)Xylocaine (Lidocaine)
Musculoskeletal Injection Musculoskeletal Injection ProceduresProcedures
Benefits of Fluoroscopic GuidanceBenefits of Fluoroscopic Guidance–– Faster and more accurate placement of Faster and more accurate placement of
needle into desired targetneedle into desired target
–– Ability to confirm location of needle tip usingAbility to confirm location of needle tip usingAbility to confirm location of needle tip using Ability to confirm location of needle tip using IodineIodine--based contrast materialbased contrast material
Omnipaque 240 (Iohexol)Omnipaque 240 (Iohexol)
IntraIntra--Articular Steroid InjectionsArticular Steroid Injections
Commonly used since the 1950sCommonly used since the 1950s
Effective for painful flareEffective for painful flare--ups of DJD and ups of DJD and RARA
Di i i h d t i ti t id idDi i i h d t i ti t id idDiminished systemic corticosteroid sideDiminished systemic corticosteroid side--effectseffects
Relatively low morbidityRelatively low morbidity
Musculoskeletal Injection Procedures April 16, 2011 3:30-5:00pm
This is the property of Andrew Cooperman, M.D. and should not be copied or otherwise used without express written permission of the author. 2
Procedure FlowProcedure Flow
Informed consentInformed consent
Sterile Prepping and DrapingSterile Prepping and Draping–– Betadine scrub and alcohol rinseBetadine scrub and alcohol rinse
Local (skin) anesthesiaLocal (skin) anesthesia
Needle placement under fluoroscopic Needle placement under fluoroscopic guidanceguidance
Procedure FlowProcedure Flow
Confirmation of desired needle placementConfirmation of desired needle placement–– Loss of resistance upon injection of local Loss of resistance upon injection of local
anestheticanesthetic
–– Injection of contrast materialInjection of contrast materialInjection of contrast materialInjection of contrast material
Save image of needle placement and Save image of needle placement and contrast patterncontrast pattern
Inject therapeutic agentsInject therapeutic agents
Procedure FlowProcedure Flow
Remove needleRemove needle
Exercise (mildly) if necessaryExercise (mildly) if necessary
PostPost--procedural interviewprocedural interview–– Degree of initial pain reliefDegree of initial pain relief
–– Assess for signs of complicationAssess for signs of complication
DischargeDischarge
Musculoskeletal Injection Procedures April 16, 2011 3:30-5:00pm
This is the property of Andrew Cooperman, M.D. and should not be copied or otherwise used without express written permission of the author. 3
Procedural RisksProcedural Risks
BleedingBleeding
InfectionInfection
Contrast allergyContrast allergy
Medication RisksMedication Risks
Local anestheticLocal anesthetic–– AllergyAllergy
–– Avoid intravascular injectionAvoid intravascular injection
C ti t idC ti t idCorticosteroidCorticosteroid–– Osteonecrosis (AVN)Osteonecrosis (AVN)
–– Exacerbation of DiabetesExacerbation of Diabetes
–– Others (Glaucoma, ulcer, headache, Others (Glaucoma, ulcer, headache, insomnia, flushing)insomnia, flushing)
Upper ExtremityUpper Extremity
ShoulderShoulder–– Glenohumeral, Subacromial, AC JointGlenohumeral, Subacromial, AC Joint
ElbowElbowI tI t A ti lA ti l–– IntraIntra--ArticularArticular
WristWrist–– Radiocarpal, Midcarpal, DRUJRadiocarpal, Midcarpal, DRUJ
Sternoclavicular JointSternoclavicular Joint
Musculoskeletal Injection Procedures April 16, 2011 3:30-5:00pm
This is the property of Andrew Cooperman, M.D. and should not be copied or otherwise used without express written permission of the author. 4
Musculoskeletal Injection Procedures April 16, 2011 3:30-5:00pm
This is the property of Andrew Cooperman, M.D. and should not be copied or otherwise used without express written permission of the author. 5
Lower ExtremityLower Extremity
HipHip–– IntraIntra--Articular, Trochanteric Bursa, Ilioposas, Articular, Trochanteric Bursa, Ilioposas,
Hamstrings OriginHamstrings Origin
KneeKneeKneeKnee
Ankle / FootAnkle / Foot–– Tibiotalar, Subtalar, etc.Tibiotalar, Subtalar, etc.
–– Diagnostic and TherapeuticDiagnostic and Therapeutic
Musculoskeletal Injection Procedures April 16, 2011 3:30-5:00pm
This is the property of Andrew Cooperman, M.D. and should not be copied or otherwise used without express written permission of the author. 6
Musculoskeletal Injection Procedures April 16, 2011 3:30-5:00pm
This is the property of Andrew Cooperman, M.D. and should not be copied or otherwise used without express written permission of the author. 7
When in doubt…When in doubt…
Radiology Consult LineRadiology Consult Line–– 888888--541541--SCAN (7226)SCAN (7226)
CDI Musculoskeletal TeamCDI Musculoskeletal TeamH lli F itt MDH lli F itt MD–– Hollis Fritts, MDHollis Fritts, MD
–– Cooper Gundry, MDCooper Gundry, MD
–– Andrew Cooperman, MDAndrew Cooperman, MD
–– Kevin Snyder, MDKevin Snyder, MD