high impact rheumatology joint examination and injection techniques part 1: upper extremities
TRANSCRIPT
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High Impact Rheumatology
Joint Examination and Injection Techniques Part 1: Upper Extremities
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Injections
• Steroids, soluble and insoluble • Triamcinolone hexacetonide (Aristospan)• Triamcinolone acetonide (Kenalog)• Methylprednisolone acetate (DepoMedrol)• Dexamethasone (Decadron)
• Local anesthetics • Bupivacaine (Marcaine)• Lidocaine (Xylocaine)
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Cautions About Injections Disinfect injection site Wear gloves for your own protection Don’t inject through cellulitis or psoriatic skin lesion Use a large-gauge needle to aspirate an inflamed
or infected joint Use small-gauge needle and hold pressure over
injection site if patient is anticoagulated Do not inject the same joint more than 3 to 4 times
a year Some steroid will be absorbed systemically and
can worsen CHF, HTN, and DM
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Anterior Shoulder Exam Sternoclavicular joint Acromioclavicular joint Glenohumeral joint Biceps tendon
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Supraspinatus tendon Infraspinatus tendon Teres minor tendon
Rotator Cuff Exam
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Insert needle 1 cm below coracoid process
Medial to humeral head
Shoulder Joint Injection
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Localize lateral midpoint of acromion
Insert 1 cm distal Angle needle upward
Subdeltoid Bursa Injection
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Lateral epicondyle at insertion of common extensor tendon
Olecranon bursa Lateral joint line
between humerus and proximal ulna for synovial swelling or effusion
Elbow Exam
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Elbow Joint Injection Midpoint of line
between lateral epicondyle and tip of the olecranon
Angle needle toward middle of antecubital fossa
Keep elbow at 90 degrees
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Palpate over proximal ulna
Olecranon Bursa
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Lateral epicondyle
Elbow Injections
Elbow joint injection
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Support wrist in 15-degree flexion
Palpate radiocarpal joint and ulnocarpal joint
Keep extensor tendons relaxed
Wrist Exam
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Wrist in 15-degree flexion
Insert needle next to extensor tendon of the thumb
Angle slightly toward distal ulna
Wrist Injection
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Support palm of hand Palpate both sides of
the joint line with thumbs
Metacarpophalangeal Joints
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Palpate both lateral joint lines with thumb and index finger while palpating volar and palmar sides with opposite thumb and finger
Finger Exam
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Finger Joint Injection 15-degree flexion Insert needle at
“2 o’clock” just into the capsule
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High Impact Rheumatology
Joint Examination and Injection Techniques Part 2: Lower Extremities
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Injections
• Steroids, soluble and insoluble • Triamcinolone hexacetonide (Aristospan)• Triamcinolone acetonide (Kenalog)• Methylprednisolone acetate (DepoMedrol)• Dexamethasone (Decadron)
• Local anesthetics • Bupivacaine (Marcaine)• Lidocaine (Xylocaine)
![Page 21: High Impact Rheumatology Joint Examination and Injection Techniques Part 1: Upper Extremities](https://reader035.vdocument.in/reader035/viewer/2022062423/5697c0041a28abf838cc48a3/html5/thumbnails/21.jpg)
Cautions About Injections
Disinfect injection site Wear gloves for your own protection Don’t inject through cellulitis or psoriatic skin
lesion Use a large-gauge needle to aspirate an
inflamed or infected joint Use small-gauge needle and hold pressure over
injection site if patient is anticoagulated Do not inject the same joint more than 3 to 4
times a year Some steroid will be absorbed systemically and
can worsen CHF, HTN, and DM
![Page 22: High Impact Rheumatology Joint Examination and Injection Techniques Part 1: Upper Extremities](https://reader035.vdocument.in/reader035/viewer/2022062423/5697c0041a28abf838cc48a3/html5/thumbnails/22.jpg)
Hip Region Exam Trochanteric bursa Femoral-acetabular joint
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Hip Joint Injection
Lateral approach to hip
Direct injection
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Knee Joint Exam Palpate synovial reflection at inferomedial and inferolateral
margins of patella
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Prepatellar Bursa
Palpate anterior surface of patella
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Knee Injection
Knee fully extended Junction upper third
and lower two thirds of the patella
Insert needle under patella and aim superiorly
© ACR
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Ankle Exam For tibiotalar joint,
palpate 1 cm anterior to distal medial malleolus just medial to extensor tendon and palpate anterior to distal fibula
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Ankle Joint Injection Insert needle 1 cm
anterior to distal medial malleolus, just medial to dorsalis pedis pulse and extensor tendon of great toe
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Lateral Foot Exam Calcaneocuboid joint
is 2 cm distal to fibula and 1 cm anterior
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Medial Foot Exam Palpate talonavicular
joint2 cm anterior to distal medial malleolus
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Metatarsophalangeal Exam
Palpate MTP joint with second and third fingers on plantar surface while stabilizing joint with thumb on anterior surface
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Interpharyngeal Joints of Toes Palpate lateral sides of
joint line with thumb and index finger
Palpate anterior and plantar surfaces with thumb and index finger of opposite hand