Injection Techniques in Musculoskeletal Medicine: A Practical Manual for Clinicians in Primary and Secondary Care

Description

The fully updated fifth edition of Injection Techniques in Musculoskeletal Medicine is a trusted step-by-step guide for a wide range of practitioners who deal with the management of painful joints and soft tissues, particularly in relation to sports and overuse injuries. Area by area guidance is given for each lesion on appropriate patient selection and delivery of the drug. Every technique has its own two-page spread; the first consisting of a detailed but easy to follow description of the causes, positive assessment findings, anatomical details and injection procedure. The facing page shows an anatomical illustration of the region and a photograph showing the landmarks for the injection. This edition features brand new full colour photographs and case studies View more > Key Features • Illustrations, references, lesions, drugs, controversies • Chapters on Other Injectable Substances; Landmark and Image Guided Injections • Latest evidence in injection therapy literature • Adapted and simplified practical sections • Brand new full colour photographs • Case studies COVER......Page 1 Inside Front Cover......Page 2 Injection Techniques in Musculoskeletal Medicine......Page 3 Copyright Page......Page 5 Dedication......Page 6 Acknowledgements......Page 7 Foreword......Page 8 Preface......Page 9 About the Authors......Page 10 1 Injection Therapy – The Evidence......Page 11 Overview......Page 15 Delivery of Injection Therapy......Page 16 The Research Agenda in Injection Therapy......Page 17 Options and Shared Decision Making......Page 18 References......Page 20 Suppressing inflammation......Page 26 • Triamcinolone acetonide......Page 27 • Hydrocortisone......Page 28 Distension......Page 29 Potential Side Effects......Page 30 Postinjection flare of pain......Page 31 Bleeding or bruising......Page 32 Steroid arthropathy......Page 33 Sepsis......Page 34 Rare local side effects......Page 36 Suppression of the hypothalamic-pituitary axis......Page 37 Significant falls in the erythrocyte sedimentation rate and C-reactive protein level......Page 38 Other rare systemic side effects......Page 39 Costs......Page 40 References......Page 41 Overview......Page 50 Hyaluronans......Page 51 Prolotherapy (Sclerosants)......Page 54 Polidocanol......Page 56 Autologous Blood......Page 57 Aprotinin......Page 58 Collagenase......Page 59 Radiosynovectomy......Page 60 References......Page 61 Needle Size......Page 68 Confirmation of Needle Placement......Page 69 Accuracy of Landmark Technique Injections......Page 70 Clinical studies supporting the accuracy of landmark-guided injections......Page 71 Clinical studies not supporting the accuracy of landmark-guided injections......Page 72 Benefits......Page 73 Image Guidance and Clinical Outcomes......Page 74 Studies That Do Not Correlate Effectiveness With Accuracy......Page 75 Why Might Close Enough Be Good Enough?......Page 77 Conclusion......Page 78 References......Page 80 Overview......Page 88 Technique......Page 89 Laboratory assessment......Page 90 Diagnosis of Sepsis......Page 91 Image-Guided Aspiration......Page 92 Frank Blood......Page 93 Serous fluid streaked with fresh blood......Page 94 Other aspirates......Page 95 Aspirating Ganglia......Page 96 Trigger Points......Page 97 References......Page 98 Acute Anaphylaxis......Page 102 Recognition of an anaphylactic reaction......Page 103 Adrenaline (epinephrine)......Page 104 Syncope......Page 105 Additional Emergency Kit for Medical Personnel......Page 106 World Anti-Doping Agency Rules......Page 107 Use of Local Anaesthetics in Competition......Page 108 Consent......Page 109 Summary of important points......Page 110 Use of Drugs Beyond Licence......Page 111 References......Page 112 2 Practical Guidelines for Injection Therapy in Musculoskeletal Medicine......Page 113 History......Page 114 Examination......Page 115 Resisted movements......Page 116 Differential diagnoses......Page 117 How to Use This Book......Page 118 Anatomical Structure/Diagnosis......Page 119 Needles......Page 120 Corticosteroids......Page 121 Mixing of drugs for UK physiotherapists and other allied health professionals......Page 122 Dosages......Page 123 Anatomy......Page 124 Technique......Page 125 Bolus and peppering procedures......Page 126 Aspiration......Page 127 Aftercare......Page 129 Relative Contraindications......Page 131 Preparation Protocol......Page 132 Injection Technique Flowchart......Page 133 References......Page 134 3 Upper Limb Injections......Page 135 Examination of the Upper Limb......Page 137 Shoulder Examination......Page 138 Additional shoulder tests if necessary......Page 139 Aftercare......Page 140 Aftercare......Page 142 Aftercare......Page 144 Aftercare......Page 146 Aftercare......Page 148 Aftercare......Page 150 Aftercare......Page 152 Aftercare......Page 154 Aftercare......Page 156 Elbow Examination......Page 158 Additional elbow tests if necessary......Page 159 Aftercare......Page 160 Aftercare......Page 162 Aftercare......Page 164 Aftercare......Page 166 Aftercare......Page 168 Wrist and Hand Examination......Page 170 Additional hand tests if necessary......Page 173 Aftercare......Page 174 Aftercare......Page 176 Aftercare......Page 178 Aftercare......Page 180 Aftercare......Page 182 Aftercare......Page 184 Aftercare......Page 186 Summary of Suggested Upper Limb Dosages......Page 188 Case History 2......Page 189 Case History 6......Page 190 Case History 10......Page 191 Case History 14......Page 192 Case History 18......Page 193 Common Extensor Tendon......Page 194 Temperomandibular Joint......Page 195 4 Lower Limb Injections......Page 196 Examination of the Lower Limb......Page 198 Hip Examination (in Supine)......Page 199 Hip Examination (In Prone)......Page 200 Additional hip tests if necessary......Page 201 Aftercare......Page 202 Technique......Page 204 Aftercare......Page 206 Aftercare......Page 208 Aftercare......Page 210 Aftercare......Page 212 Aftercare......Page 214 Knee Examination......Page 216 Additional knee tests if necessary......Page 217 Aftercare......Page 218 Aftercare......Page 220 Aftercare......Page 222 Aftercare......Page 224 Aftercare......Page 226 Aftercare......Page 228 Aftercare......Page 230 Aftercare......Page 232 Aftercare......Page 234 Aftercare......Page 236 Ankle and foot tests......Page 238 Additional foot tests......Page 239 Aftercare......Page 240 Aftercare......Page 242 Aftercare......Page 244 Aftercare......Page 246 Aftercare......Page 248 Aftercare......Page 250 Aftercare......Page 252 Aftercare......Page 254 Aftercare......Page 256 Aftercare......Page 258 Aftercare......Page 260 Summary of Suggested Lower Limb Dosages......Page 262 Case History 20......Page 263 Case History 24......Page 264 Case History 29......Page 265 Case History 34......Page 266 Case History 36......Page 267 Morton’s Neuroma......Page 268 5 Spinal Injections......Page 269 Indications for Spinal Injection......Page 270 Safety......Page 271 Lumber epidurals......Page 272 Summary......Page 273 Lumbar Spine Examination......Page 274 Eliminate sacroiliac joint as source of pain......Page 275 Lumbar spine neurological tests for nerve root mobility and muscle power......Page 276 Additional spinal tests if necessary......Page 278 Aftercare......Page 279 Aftercare......Page 281 Aftercare......Page 283 Aftercare......Page 285 Aftercare......Page 287 References......Page 289 Upper Limb......Page 292 Lower Limb......Page 293 Informed Consent......Page 294 Appendix 3 Orthopaedic Medicine Seminars: Sample of Patient Information Sheet......Page 295 Appendix 4 Frequently Asked Questions......Page 297 Appendix 5 Survey of 2051 Consecutive Musculoskeletal Injections Administered in An Outpatient Setting......Page 300