Clinical Practice

Question 1

CLINICAL PRACTICE

Indications - symptomatic

Answer 1

Symptomatic:

• reduce inflammation in chronic lesions and acute episodes or flares
• decrease pain - local/referred allowing gradual introduction of more normal mechanical loading and improved function
• use of LA
  
  • therapeutic
    
    • pain relief during and after injection
    • increase volume of injection
  • diagnostic
    
    • allows immediate re-assessment to confirm diagnosis

Question 2

CLINICAL PRACTICE

Indications - lesions

Answer 2

Lesions

Synovium

• Tenosynovitis (e.g. de Quervains)
• arthritis (e.g. OA)
• Capsulitis
• Acute or chronic bursitis

“Others”

• nerve entrapment syndrome (e.g. carpal tunnel)
• other peri-articular lesions (e.g. trigger finger)
• Tendinopathy (e.g. tennis elbow, achilles tendon)

Question 3

Clinical Practice

CONTRAINDICATIONS

ABSOLUTE

Answer 3

• lack of consent
• Infection
  
  • in the joint
  • local sepsis
  • significant systemic illness
  • osteomyelitis
• hypersensitivity to LA (or steroid)

Question 4

Clinical Practice

CONTRAINDICATIONS

CAUTION

Answer 4

• recent history of trauma
• haemarthrosis (aspiration may be apropriate)
• concurrent oral steroids
• anticoagulant therapy/bleeding disorders
• immunosuppression
• poorly controlled diabetes
• anxious/psychogenic patient
• prosthetic joint
• pregnant/breast-feeding/shildren and adolescents