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Injection Techniques in Musculoskeletal Disorders
Janak Parmar
CHAPTER 1:
General Consideration in Injection Technique
ARTHRITIS (FLOW CHART 6 OF ANNEXURE)
Rheumatoid Arthritis
Role of Corticosteroids
Crystal Induced Arthropathy
Ankylosing Spondylitis
Traumatic Bursitis Respond Favorably to Aspiration
Syringes and Needles Used
INJECTABLE CORTICOSTEROIDS
Mechanism of Action
Safety
Side Effects
Systemic Side Effects
Structure Lesion Relationship
TRIAMCINOLONE ACETONIDE INJECTION
HYALURONIDASE
Adult Dosage
Adverse Reactions
PLATELET RICH PLASMA (FIGS 1.3 AND 1.9)
INTRA-ARTICULAR ASPIRATIONS
Indications
Contraindications
Complications
SYNOVIAL FLUID (FIG. 1.5 AND FLOW CHARTS 1 AND 7 OF ANNEXURE)
Ultrasonographic Appearance of Tendons (Figs 1.6 and 1.11 and Flow chart 2 of Annexure)
CHAPTER 2:
Shoulder
SURFACE ANATOMY OF SHOULDER (FIGS 2.1 TO 2.8)
SUBDELTOID/SUBACROMIAL BURSITIS (FIGS 2.9 TO 2.25)
Technique
Posterior Approach
Lateral Approach
ULTRASONOGRAPHY GUIDED INJECTION (FLOW CHART 2.1 AND FIGS 2.9 TO 2.20)
Quadrilateral Space
Triangular Space
Position of Transducer (Fig. 2.9)
Above it is Deltoid (Figs 2.10 to 2.12)
Concave Subdeltoid Fat Counter (Figs 2.10, 2.12, 2.17)
BICIPITAL TENOSYNOVITIS
Technique (Figs 2.28 and 2.30 and Flow Chart 2.1)
ULTRASOUND GUIDED INJECTION IN BICEPS TENDON (FIGS 2.26 TO 2.32)
Glenohumeral Joint Injection
Technique (Figs 2.19, 2.33 to 2.36)
Posterior Approach
Anterior Approach
Lateral Approach
Ultrasonography Guided Injection is Helpful
CALCIFIC TENDINITIS (FIG. 2.16)
ADHESIVE CAPSULITIS
ACROMIOCLAVICULAR JOINT
Differential Diagnosis
Technique (Figs 2.19, 2.37 to 2.40)
SUPRASPINATUS INFILTRATION
Technique
INFRASPINATUS TENDON INFILTRATION (FIGS 2.41 TO 2.44)
Technique
SUBSCAPULARIS TENDON INFILTRATION
Technique
ROTATOR CUFF ARTHROPATHY
CHAPTER 3:
Elbow
SURFACE ANATOMY OF ELBOW (FIGS 3.1 TO 3.7)
WRIST EXTENSOR GROUP
TENNIS ELBOW (FIG. 3.27)
Technique (Figs 3.8 to 3.15)
ULTRASONOGRAPHY GUIDED INJECTION FOR TENNIS ELBOW (FIGS 3.8 TO 3.11 AND 3.15)
GOLFER ELBOW (SWIMMERS ELBOW OR EPITROCLEITIS) (FIG. 3.27)
Technique (Figs 3.5, 3.16 and 3.17)
Ultrasonography Guided Injection for Golfer Elbow (Figs 3.16 and 3.17)
OLECRANON BURSISTIS: (MINERS ELBOW OR DRAFTSMAN'S ELBOW) (FIG. 3.27)
Technique (Figs 3.18 to 3.20)
ELBOW JOINT ASPIRATION (FIG. 3.27)
Technique (Figs 3.21 to 3.24)
CUBITAL TUNNEL SYNDROME (FIG. 3.27)
Technique
Ultrasonography Guided Injection (Figs 3.25 and 3.26)
POSTERIOR INTEROSSEOUS NERVE SYNDROME
Technique
CHEIRALGIA PARESTHETICA
Technique
CHAPTER 4:
Wrist and Hand
ANATOMICAL SNUFF BOX (FIG. 4.41A)
FLEXOR COMPARTMENT WRIST
FINGER FLEXOR TENDON PULLEY SYSTEM
TRIANGULAR FIBROCARTILAGE COMPLEX
FLEXOR TENDONS AND CARPAL TUNNEL
Triangular Fibrocartilage Complex
Extensor
WRIST JOINT (FIGS 4.1 TO 4.3 AND 4.39)
Technique
DISTAL RADIOULNAR JOINT
Technique
CARPAL TUNNEL SYNDROME (FIGS 4.4 TO 4.8)
Technique
FIRST CARPOMETACARPAL JOINT (FIG. 4.9)
Technique
METACARPOPHALANGEAL, PROXIMAL AND DISTAL INTERPHALANGEAL JOINT (FIGS 4.10 TO 4.12 AND 4.38 TO 4.40)
Technique
TRIGGER FINGER (FIGS 4.13 TO 4.20) ALSO KNOWN AS STENOSING TENOVAGINITIS
Technique
Ultrasonography Guided Injection for Trigger Finger (Figs 4.14 to 4.20)
DE QUERVAIN TENOSYNOVITIS (FIGS 4.21 TO 4.30 AND 4.41C) ALSO KNOWN AS STENOSING SYNOVITIS OF FIRST DORSAL COMPARTMENT
Technique
GANGLION: CYSTIC TUMOR OR GANGLION CYST (FIGS 4.31 TO 4.33)
Technique
ULNAR TUNNEL SYNDROME (FIGS 4.34 TO 4.37 AND 4.41B)
Technique
CHAPTER 5:
Chest
COSTOSTERNAL SYNDROME (FIGS 5.1 AND 5.2)
Technique
TIETZE'S SYNDROME
Technique
MANUBRIOSTERNAL JOINT PAIN SYNDROME
Technique
STERNALIS SYNDROME
Technique
STERNOCLAVICULAR JOINT (FIGS 5.3 AND 5.4)
Technique
XIPHODYNIA SYNDROME (FIG. 5.5)
Technique
LUMBAR MYOFASCIAL PAIN SYNDROME
Technique
CHAPTER 6:
Spine
ANATOMICAL AND PHYSIOLOGICAL CONSIDERATIONS (FIGS 6.1 TO 6.12)
ALBERT SCHWEITZER
Pathology
RISK FACTORS FOR LOW BACK PAIN
EPIDURAL STEROIDS (FIGS 6.13 TO 6.16 AND FLOW CHARTS 6.1 TO 6.4)
Important Indication is Radicular Pain
Lumbar Epidural Steroids
Advantage of Interlaminar Technique
Disadvantages of Interlaminar Technique
Caudal
Epidural Steroid are Useful
Response Vary Greatly
Contraindications
Complications
Useful Tips for Injection Technique
Technique
Interlaminar Approach (Fig. 6.19)
Transforaminal Approach (Figs 6.12, 6.21 to 6.28 and Flow Chart 6.5)
TRANSFORAMINAL BLOCK
Tips for Injection
CAUDAL APPROACH (FIGS 6.29 AND 6.30)
Caudal Epidural Steroids (Blinded)
Postprocedure
Cervical Epidural Steroid
FACET JOINT (FLOW CHARTS 6.1 TO 6.4)
Anatomy (Figs 6.12, 6.31 and 6.32)
Pathology: Synovitis of Facet Joint
Hemarthrosis
Delphi Experts Diagnostic Criteria for Facet Arthropathy
Arthritis of Facet Joint was Defined by James in 2007
In Disk Height Reduction
Radiofrequency Techniques
INTRA-ARTICULAR LUMBAR FACET JOINT BLOCKS (FIGS 6.31 TO 6.37)
Performed Under Image Intensifier
LUMBAR MEDIAN BRANCH BLOCK
Postprocedural Care
Complications
Myofascial Pain
SACROILIAC JOINT BLOCK (FIG. 6.38 AND FLOW CHART 6.5)
Procedure
Discography
Provocation Discography (Figs 6.39 and 6.40)
Components
Lumbar Discography Identifies Symptomatic and Pathological IVD's
Technique
VALUE OF DISCOGRAPHY
PROTOCOL FOR DIAGNOSTIC AND THERAPEUTIC SPINE INJECTIONS FOR BACKACHE (FLOW CHART 6.1 TO 6.4)
CHAPTER 7:
Hip and Pelvis
SURFACE LANDMARKS (FIGS 7.1 AND 7.2)
HIP JOINT (FIGS 7.3 TO 7.5 AND FLOW CHART 7.1)
Technique
HIP INJECTIONS: C-ARM GUIDED (FIG. 7.4)
TROCHANTERIC BURSA (FIGS 7.6, 7.7 AND 7.14A)
ADDUCTOR TENDINITIS (FIG. 7.8)
Technique
MERALGIA PARESTHETICA (FIGS 7.9 TO 7.11)
Technique
ISCHIAL BURSITIS/ISCHIOGLUTEAL BURSITIS (TAILOR'S OR WEAVERS BOTTOM) (FIG. 7.14A)
Technique (Fig. 7.12)
GLUTEAL BURSITIS
Technique
USG Guided Injection (Fig. 7.12)
PSOAS BURSITIS PAIN (FIG. 7.14A)
Technique
OSTEITIS PUBIS SYNDROME
Technique
COCCYDYNIA (FIG. 7.13)
COXA SALTANS
Technique
CHAPTER 8:
Knee and Ankle
KNEE JOINT (FIGS 8.1 TO 8.15)
Technique
JUMPERS KNEE (FIGS 8.16 AND 8.17)
Technique
TIBIOFIBULAR JOINT (FIGS 8.18 TO 8.20)
Technique
TIBIAL COLLATERAL LIGAMENT FIBROSITIS AND BURSITIS
Technique
FIBULAR COLLATERAL LIGAMENT BURSITIS
Technique
MEDIAL GASTROCNEMIUS BURSITIS
Technique
SEMIMEMBRANOSUS BURSITIS
Technique
HAMSTRING TENDONITIS (FIG. 8.21)
Technique
POPLITEAL BURSA (FIGS 8.22 TO 8.26)
Technique
USG Guided Injection
SUPRAPATELLAR BURSA (FIGS 8.27 AND 8.28)
Technique
PREPATELLAR BURSA (HOUSEMAIDS KNEE) (FIG. 8.29)
Technique
INFRAPATELLAR BURSITIS (CLERGYMAN'S KNEE, PARSON'S OR CARPET-LAYER'S KNEE) (FIG. 8.30)
Technique
PES ANSERINE BURSITIS (FIGS 8.31 TO 8.34)
Technique
Popliteofibular Ligament (Fig. 8.35)
Lateral Collateral Ligament
Biceps Femoris
Lateral Head of Gastrocnemius (Fig. 8.35)
Arcuate Ligament (Fig. 8.35)
FOOT AND ANKLE (FIGS 8.36 TO 8.38)
SOLE
ANKLE JOINT (FIGS 8.39 TO 8.45)
Technique
USG Guided Ankle Joint Injections
SUBTALAR JOINT (FIGS 8.46 TO 8.48)
Technique
Midtarsal Joint (Fig. 8.57)
Technique
TENDINITIS OF ACHILLES TENDON (FIGS 8.49 TO 8.56 AND 8.115B)
Technique
Flexor Hallucis Longus (Figs 8.110 to 8.113)
GREAT TOE PAIN: HALLUX VALGUS (FIGS 8.57 TO 8.60)
Technique
BUNIONETTE (TAILORS BUNION) (FIGS 8.61 TO 8.64)
Technique
PLANTAR FASCIITIS (FIGS 8.65 TO 8.71 AND 8.115A)
Technique
RETROCALCANEAL BURSITIS (FIGS 8.66 AND 8.115B)
Technique
PERONEAL TENDINITIS (FIGS 8.72 TO 8.77)
Technique
TIBIALIS POSTERIOR TENDONITIS (FIGS 8.78 TO 8.83)
Technique
USG Guided Injection
CHRONIC DELTOID LIGAMENT INJURY (FIGS 8.84 AND 8.115B)
Technique
Posterior Deltoid Ligament
Anterior Deltoid Ligament
CHRONIC ANTERIOR TALOFIBULAR LIGAMENT INJURY (FIG. 8.85)
Technique
ANTERIOR TIBIOTALAR JOINT (FIGS 8.86 TO 8.93)
Anterior Talofibular Ligament
CHRONIC FIBULOCALCANEAL LIGAMENT INJURY (FIGS 8.94 AND 8.95)
Technique
TARSAL TUNNEL SYNDROME (FIG. 8.115B)
Technique
MALLET TOE PAIN SYNDROME
Technique
MORTON'S NEUROMA (FIG. 8.96)
Technique
SESAMOIDITIS (FIGS 8.97 AND 8.115A)
Technique
METATARSALGIA (FIG. 8.115A)
Technique (Figs 8.98 to 8.115)
Annexure
INDEX
TOC
Index
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