A Practical Guide to Joint & Soft Tissue Injection

Contents
Foreword iv
Preface vi
1. INTRODUCTION 1
2. FOUNDATION CONCEPTS 2
Thoughtful Consideration 2
When to Refer to a Subspecialist 2
Standard Medication Management 3
Indications for Injections and Aspirations 5
Contraindications to Injections and Aspirations 6
Special Medical Conditions 8
Complications 8
Safety 10
Anatomy 11
Landmarks 12
Topical Anesthesia 12
Equipment 13
Landmark-Guided Injection Technique 15
Synovial Fluid Analysis 15
Aftercare 16
Documentation of the Procedure 17
Billing and Coding 18
Informed Consent 19
Evidence-Based Medicine 20
3. INJECTABLE AGENTS 24
Local Anesthetics 24
Corticosteroids 26
Viscosupplements 29
Botulinum Toxin 32
Other 33
4. ORTHOBIOLOGICS 35
Regenerative Medicine 35
Prolotherapy 36Autologous Blood 37
Platelet-Rich Plasma 38
Stem Cells 38
5. MUSCULOSKELETAL ULTRASOUND 42
Indications 42
Contraindications 43
Normal Ultrasound Anatomy Signals 43
Ultrasound Needle-Guidance Terminology 47
Ultrasound and Needle Guidance 47
Ultrasound Guidance of Procedures 50
New Ultrasound Technology 54
6. ADVANCED AND ADJUNCTIVE TECHNIQUES 56
Auricular Battlefield Acupuncture 57
Barbotage 62
Tendon Brisement/High-V olume Injection 66
Fenestration (Percutaneous Tenotomy) 69
Nerve Hydrodissection 73
Capsular Hydrodilatation/Hydroplasty 77
Myofascial Trigger Point Dry Needling 80
Tenotomy With Debridement 85
7. SKIN ANESTHESIA 88
Direct Local Injection 88
Field Block Injection 91
Digital Nerve Block 94
Facial Nerve Blocks 98
Supraorbital and Supratrochlear Nerve Blocks 100
Infraorbital Nerve Block 103
External Nasal Nerve Block 106
Mental Nerve Block 108
External Ear Field Block 111
Greater Occipital Nerve Block 114
Headache Nerve Blocks 118
8. SKIN AND SKIN STRUCTURES 122
Chalazion 122
Keloid Scar 126
Common Warts 129
Granuloma Annulare and Other Thin, Benign, Inflammatory Dermatoses 132
Prurigo Nodularis and Other Thick, Benign, Inflammatory Dermatoses 1369. HEAD AND TRUNK 139
Temporomandibular Joint 139
Suprascapular Nerve 144
Scapulothoracic Syndrome 148
Sacroiliac Joint 152
10. UPPER EXTREMITIES 156
Subacromial Space Injection—Posterior Approach 156
Glenohumeral Joint—Posterior Approach 162
Acromioclavicular Joint 167
Sternoclavicular Joint 171
Biceps Tendon—Long Head 175
Cubital Tunnel Syndrome 179
Elbow Joint 183
Olecranon Bursa 187
Lateral Epicondyle 191
Medial Epicondyle 196
Radial Nerve Entrapment 200
Intersection Syndrome 204
de Quervain’s Tenosynovitis 208
Carpal Tunnel Syndrome—Preferred Flexor Carpi Radialis Approach 212
Carpal Tunnel Syndrome—Traditional Approach 218
Wrist Joint 222
Dorsal Wrist Ganglion Cyst 226
Thumb Carpometacarpal Joint 230
Metacarpophalangeal Joint 234
Trigger Finger 238
Digital Mucous Cyst 242
11. LOWER EXTREMITIES 246
Hip Joint—Preferred Lateral Approach 246
Hip Joint—Anterior Approach 251
Piriformis Syndrome 255
Hamstring Tendon and Ischial Bursa 259
Meralgia Paresthetica 263
Greater Trochanteric Pain Syndrome 267
Gluteal Pain Syndrome 271
Hip Adductor Tendon 275
Knee Joint Injections 279
Knee Joint—Preferred Lateral Suprapatellar Approach 283
Knee Joint—Lateral Midpatellar Approach 290
Knee Joint—Anteromedial and Anterolateral Approaches 295
Knee Joint—Popliteal Synovial (Baker’s) Cyst 300
Prepatellar Bursitis 305Patellar Tendon 309
Pes Anserine Syndrome 311
Iliotibial Band Friction Syndrome 315
Achilles Tendon 319
Tibialis Posterior Tendonitis 321
Tarsal Tunnel Syndrome 324
Ankle Joint—Anterolateral Approach 328
Ankle Joint—Anteromedial Approach 332
Fibularis Brevis Tendonitis 336
Plantar Fascia 340
Midfoot Joints 344
First Metatarsophalangeal Joint 347
Intermetatarsal (Morton’s) Neuroma 351
APPENDIX 1: CONSENT FOR NEEDLE ASPIRATION
AND/OR INJECTION 355
APPENDIX 2: ASPIRATION AND INJECTION AFTERCARE
HANDOUT 357
APPENDIX 3: MEDICAL RECORD DOCUMENTATION 359
Index 361