Intra-articular & Allied Injections Sureshwar Pandey, Anil Kumar Pandey
Page numbers followed by f refer to figure.
Abductor pollicis longus 37
Acetonide, triamcinolone 71
Achilles tendinitis 55
Acupressure 8587
Acupuncture, complications of 86
Adventitious superficial pretendinous achilles bursa 55
Allergic rhinitis, recurrent 71
Alopecia 14
Analgesic 8, 79
Ankylosing spondylitis, peripheral synovial swelling of 12
Ankylosis, fibrous 12, 71
Anorexia 92f
Anserinus bursa 49
Apophysitis 12
calcaneal 12, 55, 56f
Arthritis 86
crystal 51
degenerative 51
gouty 51, 58
infective 78
rheumatoid 12, 17, 51, 58, 70
traumatic 16, 51
Arthropathy 79
Arthrosis, degenerative 71
Asthma 93f
Atrophy 79
Backache 14
Bacteraemia 78
Bell's palsy 75
Bhadrasan 91
Bhujangasan 93f
Blood transfusion 80
Botulinum toxin 82, 83
role of 82
Budha's position 45
Bupivicaine 8
Calcaneal spur syndrome 55
Cerebellar artery
anterior inferior 77
superior 77
Cerebellopontine angle 77
Chloroquine 8
Chymopapain 60
Coccydodynia 67, 68f
Coccyx, painful 67
Colles fracture 36
Computer controlled local anaesthetic delivery system 25
Corticosteroid 3, 19, 80
cocktail injection 77
infiltration 14
injection 11, 12, 13, 70
intra-articular 7
ophthalmic indications of 75
therapy 16, 79
Crohn's disease 87
Cytostatica 8
De-Quervain's disease 12, 37, 38, 38f, 86, 87
Dermatitis 14
Dextrose 8
Diatrizoate meglumine 61
Discography 61
Disseminated lupus erythematosus 14
Dyspepsia 92f
Elbow 32
Electrolyte balance 80
lateral 10, 12, 33
medial 12, 35
Epidermoid 77
Epidural injections, complications of 65
pollicis brevis tendon 37
tendon, ganglion of 39f
Extracorporeal shock-wave therapy 34
Fibro-fatty nodules 14, 68, 68f
Fibrositis, recurrent 69
Fractures, intra-articular 12, 16
Freiberg's infarction 15
Ganglion 37
intra-articular 39f
Gastrointestinal system 94f
Glucocorticoids 2
Glucosamine 8
Glucosaminoglycan 17
Golfer's elbow 10, 12, 35
Haemarthrosis 12
Haemostatic disorder 16
Haglund deformity 55
Hallux rigidus 15
Hallux valgus 15
Hansen's disease 66
Hansen's neuritis 14, 26
Hansen's neuropathy 66
Hansen's pathology 75
Hathyoga 91
Heel syndrome, painful 53, 55f
Hexacetonide, triamcinolone 80
Hyaluronan solution 17
Hyaluronate 17
Hyaluronic acid 19
intra-articular 17
role of 17, 19
Hyaluronidase 7
Hydrocortisone acetate 6
Indoprofen 8
management of 79
sites of 61f
International Yoga Day 90
Intra-articular injections, complications of 78
Iothalamate meglumine 61
Ischiogluteal bursitis 15
Jaw, postoperative ankylosis of 72
acromioclavicular 73, 74f
ankle 51, 52f
around clavicle 73
degenerative arthrosis of 12
disruption, severe 16
elbow 32, 33f, 34f
facet 65
hip 42, 43f
interphalangeal 40, 40f, 58
knee 23f, 45, 46f48f, 49
metacarpophalangeal 40
metatarsophalangeal 58
neuropathic 16
post-immobilization stiffness of 12
post-traumatic stiffness of 12
recurrent subluxation of 72
sacroiliac 59, 69f, 70
shoulder 27, 28f30f
sprained ligaments of 13
sternoclavicular 73, 74f
strained ligaments of 13
subtalar 54f, 58
surface, aseptic necrosis of 26
unstable 16
wrist 36, 37f
Karma yoga 91
Keloid 14
Kidney function 80
Knee 9
primary osteoarthritis of 12
Kyphoplasty 66
Lactic acid 8
Leucoderma 14
nonspecific inflammation of 14
post-traumatic adhesions of 13
Little league elbow syndrome 35
Lumbar disc disease 60, 61f
Lung diseases 93f
Makarasan 93f
Meningioma 77
Meralgia paresthetica 14, 43, 43f
Methylprednisolone acetate 81
Metrizamide 61
Mickel's cave 77
Morphine 8
Morrant-Baker cyst 48
Morton's toe 15
Mucopolysaccharide polysulfuric acid ester 8
peripheral 14, 59, 66
root injection, method of 66
trigeminal 76f
Neuralgia, trigeminal 75, 76, 76f, 77
adhesive 14
herpetic 60, 61f
peripheral 14
acoustic 77
painful 14
Nodule, fibrotic 13
Old pelvic fracture 69
Olecranon bursitis 34, 34f
Osgood-Schlatter disease 12, 49, 50f
Osteoarthritis 19
management of 17
Osteoporosis, severe 16
Padmasan 91, 92f
Pellegrini-Stieda disease 13
Periarthritic infiltration 28, 29f
Periarthritis shoulder 12
Perinural adhesions, post-traumatic 14
Peroneus longus tendon 53, 54f
Phenylbutazone 8
Pitcher's elbow 35
Plantar fasciitis 14, 55, 56, 57f
Platelet-rich plasma 17, 20
Polymethylmethacrylate 66
Popliteal nerve 67
lateral 49, 50f
Post-achilles bursitis 55, 56f
Pre-achilles bursitis 55, 55f
Psoriatic arthropathy 12
Pyaemia 78
Radiculitis 14
Reflex sympathetic dystrophy syndrome 15
Reiter's syndrome 12
Retromastoid cranioctomy 77
Rhinitis, atrophic 71
Sacral hiatus 63, 63f
Sarpasan 91
Sciatic nerve 69, 69f
Sclerosis, multiple 77
Septicaemia 78
Shock 80
Shoulder syndromes, painful 87
Sidhasan 91
Sodium pentosan polysulfate 8
Somatostatin 8
Sphenopalantine neuralgia 77
Spine 59
ankylosing 70, 93f
rheumatoid 70
cervical 93f
lumbar 93f
Sports injuries, acute 21
Staphylococcus aureus 78
Stenosing tenosynovitis 37
Steroid 79
Sukhasan 91
Suprapatellar pouch 47f
Surya namaskar 94f
Synovitis 72
traumatic 51
Tailor's bunion 15
Temporomandibular joint 72f
Tendon 13
injuries, chronic 21
ruptures 79
Tennis elbow 33
extra-articular 12, 33
Tenosynovitis, bicipital 31
Tenoxicam 8
Thoracic region 62
Tibial tuberosity, apophysitis of 49
Tibialis posterior
tendon 53f
tendo-vaginitis of 58
Trigeminal ganglion balloon compression 77
Ulnar nerve 67
Vajrasan 92f
Vascular compression 77
Vertebroplasty 66
B complex 79
C 79
Xiphisternum 73
Yoga 90
Zygapophyseal joint 65
Chapter Notes

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Third Edition
Sureshwar Pandey MBBS (Hons) MS (Gen) FICS FIAMS MS (Ortho) FACFAC FACS FNAMS Professor Emeritus, University of Ranchi Founder and Founder Director, GNH Handicapped Children Hospital and RJS Artificial Limb Centre Founder and Consultant, Ram Janam Sulakshana Institute of Orthopaedics and Research Ranchi, Jharkhand, India Founder and Emeritus President and Ex-Secretary General, Indian Foot and Ankle Society [Affiliated to International Federation of Foot and Ankle Societies (IFFAS)] Founder and Emeritus Editor, The Journal of Foot and Ankle Societies Surgery Visiting Professor, Universities of Tokyo, Osaka, Teikyo, Adelaide, Flinders, Ujung Pandang, Singapore Ex-Chairman ASIA-CIP (IFFAS) Founder and Chairman, Ram Janam Sulakshana Pandey Cancer Hospital & Research and Rehabilitation Centre, Ranchi Hon President, Asia-Pacific Society for Foot and Ankle Surgery • Best Book Award of BOS (2000–2001) for his Book Clinical Orthopaedics Diagnosis, 2nd Edition • Best Book Award of BOA 2002 for his Unique Books • Best Book Award (2009–2010) for his book The Clubfoot Revisited Anil Kumar Pandey MBBS CORM PhD (Orth) MAMS Director and Consultant Ram Janam Sulakshana Institute of Orthopaedics and Research (RJSIOR) Associate Director and Consultant GNH Handicapped Children Hospital and RJS Artificial Limb Centre Executive Director and Consultant Ram Janam Sulakshana Pandey Cancer Hospital and Research and Rehabilitation Centre Ranchi, Jharkhand, India Consultant, Kiran Centre for Education and Rehabilitation Varanasi, Uttar Pradesh, India Consultant, RAHA, Chhattisgarh, India Reconstructive Surgeon, Rotary International Project, Government of Nigeria Foreword Padma Bhushan Dr B Mukhopadhaya
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Intra-articular and Allied Injections
First Edition: 1982
First Japanese Edition: 1987
Second Edition: 2005
American Edition: 2007
Third Edition: 2017
FM5Dedicated to
The fond memory of my beloved parents
Sulakshana Pandey
Ramjanam Pandey
who were, are, and will be
always with me to love, teach and guide
who taught me to persue my
dreams—because nothing is impossibleFM6FM7
The Hindu God of Medicine
Commonly worshipped as the Hindu God of Medicine, Dhanvantari is regarded as the original exponent of Indian medicine. Dhanvantari has many myths and legends woven around him. He emerged with the pot of ambrosia (symbolic of medicine) in his hand from the ocean when it was churned by the contesting gods and demons. He is viewed as the very incarnation of God VISHNU. He is said to have recovered ambrosia which had been lost, and thus obtained a share in sacrifices.
Legends make him reappear as “Divodasa”, the prince of Banaras (Kasiraja), in the family of Ayus. Dhanvantari, Divodasa and Kasiraja are names of the same person who is “the first God and who freed the other Gods from old age, disease and death”, and who in his Himalayan retreat taught surgery to Susruta and other sages. Dhanvantari FM8appeared on earth in Banaras in the princely family of Bahuja and became known as Divodasa; he wandered about as a mendicant even during his early years.
Dhanvantari also appears to have been an actual historical person, although his precise identity is hard to be ascertained. He taught surgery and other divisions of Ayurveda (Indian System of Medicine) at the instance of Susruta, to a group of sages among whom Susruta was the foremost.
Dhanvantari is regarded as the patron-God of all branches of medicine. While Dhanvantari is not credited with any medical treatise of his own, in the early accounts, there is a voluminous glossary and materia medica in the nine sections known as Dhanvantari-Nighantu; it is a compilation which is probably contemporaneous with the famous Amara-Kosha (AD 100). There are a few other works which are also ascribed to Dhanvantari.
There are numerous preparations which are ascribed to him, and many of them are quite ancient.
Dhanvantari-Nighantu is considered the most ancient of the medical glossaries that are available. The original work is said to have been in three recensions; the present version which may have been based on one of them, is in six sections and deals with 373 medicinal substances; their names, synonyms, and brief description of properties being given. The work which claims to be ‘like the third eye’ for the practising physician, is extensively relied upon, despite several more comprehensive glossaries that have been compiled subsquently. Since there is no authentic source of information, this text can be considered more as indicative.
(By courtesy Pfizer Limited)
FM9Charak Oath
Oath (for a Medical Practitioner)
“Not for the self,
Not for the fulfillment of any worldly material desire or gain, but solely for the good of suffering humanity, I will treat my patient and excel all”
Local injection of hydrocortisone, whether intra-articular or extra-articular, is today an accepted method of treatment for a variety of painful conditions, although its exact manner of action is not completely understood, its usefulness is beyond question.
No monograph detailing the proper procedure of these injections is available. The result of treatment depends largely on the exact location of the injection. Dr Pandey's monograph is, therefore, not only timely but is sure to prove valuable for those who use this method of treatment for their patients.
Padma Bhushan Dr B Mukhopadhaya
MBBS (Hons) FRCS (Eng) MCh Orth (L Pool) FAMS
Professor Emeritus, Patna University
Hunterian Professor, Department of Orthopaedics
Royal College of Surgeons, England
Vice-President, Medical Council of India
Artificial Limb Manufacturing Corporation of IndiaFM12
As our first attempt to write a book, this monograph came out of press as Intra- articular and Allied Injections in 1982. Since then, beyond our expectations this practical handbook became popular in many countries of the world with its English, Japanese and American editions. This proved to be a useful guide for the interns, registrars, practitioners rheumatologist, acupuncture practitioners and orthopaedic surgeons.
In this third edition, besides updating the manuscript, here and there, small sections have been added on acupressure and yoga and the role of platelet-rich plasma (PRP) injections as the introductory knowledge. We humbly solicit the esteemed opinion, advices and guide to improve the monograph further.
Sureshwar Pandey
Anil Kumar PandeyFM14
It is always difficult to organise and sustain academic activity especially in print format, but for the doggedness and sustained enthusiasm, which only gets augmented by the observations over the subjects—the patients. We are obliged to them for providing experiences to us to the extent which stimulated us to bring out the third edition. To upgrade the Second Edition we have taken help from different sources—we are obliged to them, especially the two books—(1) Campbell's Operative Orthopaedics, 12th Edition by S Terry Canale and James H Beaty (Editors), Mosby: Elsevier, 2013. (2) Orthopaedic Management in Cerebral Palsy, 2nd Edition by Helen M Horstmann and Eugene E Bleet, Mac Keith Press, 2007.
Unless the users, the young orthopaedic and general surgeons, rheumatologists and even general practitioners, would have accepted the first edition willingly, the stimulus to bring out the third edition would not have been sustained. We are indebted to them.
Arranging the manuscript and putting them in proper order and further printing it out are really great annoying jobs. These all have been very gladly and patiently done by my dear granddaughter Dr Pallavi. I (SP) cannot return her debt.
My (SP's) grandchildren—Dr Pallavi, Dr Sangam, Dr Shivam, Dr Vaishnavi, Dr Soumya, Shruti, and Satyam and my great grand child Atharva Pranjal Kanha have been real source of easing tensions of my life with pleasant moments with them—God bless them always.
I bow my head to the feet of my reverend illustrious fatherly teacher Padma Bhushan Emeritus Professor B Mukhopadhaya, who remained the perennial source of inspiration for me.
How can I forget the immense help of Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Group President) of M/s Jaypee Brothers Medical Publishers (P) Ltd, and all persons involved in producing such a nice monograph. We are really thankful to one and all of Jaypee—The Health Sciences Publisher.