Intra articular injection by dr. ahmed shedeed مشروع إعداد طبيب حكيم ناجح

1. INTRA ARTICULA INJECTIONS
Dr. Ahmed Shedeed Abdel Ghaffar
Resident of Orthopaedics
Railways Hospital
Member of AOTrauma foundation
Member of Egyptian Orthopaedic Association
dr.ahmedshedeed@yahoo.com

2. Objectives
• Goal of intra articular injections
• Sites of intra articular injections
• The substances which are used in intra
articular injections
• Approaches of main intra articular
injections
• Results gained from intra articular
injections

3. Goal of intra articular injections
• Intra articular injection is not the
definitive treatment at all

4. uses
• Lubricating ability for relieving pain
• Reduces pain by coating damaged joint
surfaces
• Anti inflammatory action
• Test for Diagnosis

5. Sites of intra articular injections
Not only the joints can be injected but also
mostly of the injection sites are on the direct
spot of the lesion:
• Knee
• Shoulder
• Elbow
• Carpal tunnel
• Trigger finger
• Calcaneal spur
• Tenosynovitis
• De quervan

6. The substances which are used in
intra articular injections
• Corticosteroids
• local anesthetics
• hyaluronic acid

7. Knee injections
We mostly use knee injections in patients with
osteoarthritis who is :
• Not getting pain relief from :
NSAIDS
Physiotheraby
Weight Reduction

8. • Steroids has no role in relieving pain in
osteoarthritic Knee and it can cause more
deterioration for the joint by increasing the
wearing out of the cartilage
• We mostly use Hyaluronic acid as It is a
viscosupplementation injection that lubricates and
cushions the joint and Can provide pain relief up
to 9 months
• BUT AGAIN : IT’s NOT THE DEFENITIVE
TREATMENT

9. Approach
• The goal of the injection is to apply the
injected material in the space between the
femoral condyles and behind the patella
• We have 6 approaches for knee
Injection
DO NOT INJECT INFLAMMED ,
EDEMATOUS OR INFECTED KNEE

10. Results gained
• Relieving the pain resulted from the power of
friction that may help the patient for making
more exercise seeking for WEIGHT
REDUCTION and PHYSIOTHERABY
• BUT Avoid violent activities like jogging
sports for first 48 hours

11. Shoulder injections
Actually we almost don’t inject the shoulder
joint itself by the meaning of intracapsular like
the Knee but we inject different sites at the
SHOULDER REGION
the most injecting site is
Subacromion injection even for relieving pain
resulted from supra spinatous impengment
and subacromion bursitis or for testing

12. Anatomy

13. Shoulder Impingement Syndrome
• It occurs when there is impingement of
tendons or bursa in the shoulder from bones
of the shoulder. Overhead activity of the
shoulder, especially repeated activity, is a risk
factor for shoulder impingement syndrome.
Examples include: painting, lifting, swimming,
tennis, and other overhead sports. Other risk
factors include bone and joint abnormalities.

14. Goal of injection
• TESTING for confirm diagnosis by injecting
anesthetics agent for relieving the pain that
help the patient for increasing the range of
motion of the shoulder SO the diagnosis is
primary confirmed as impingement cause
But if the movement is not enhanced after
anesthetics injection SO the diagnosis is
primaray confirmed as Central Nervous Cause

15. Approach
Post Approach :
• the acromion is identified, and at a point
approximately 1 inch posteriorly the
acromioclavicular joint space is identified.
• The needle is then carefully advanced
through the skin and subcutaneous tissues
medially at a 20-degree angle

17. We also can use ultra sound guided
injection for more accurate site of
injection

19. STEROID INJECTION
• We can add steroid substance for the injection
solution to decrease the tenosynovitis
• But not repetitive avoiding wearing out and
sloughing of the tendon

20. Carpal tunnel Syndrom
• Carpal tunnel syndrome is caused by
compression of the median nerve as it passes
through the carpal canal at the wrist
• This entrapment neuropathy manifests as
pain, numbness, paresthesias, and associated
weakness in the hand and wrist that radiates
to the thumb, the index and middle fingers,
and the radial half of the ring finger

21. Anatomy

22. Goal of injection
• Relieving mild inflammation and fibrosis
around the median nerve seeking for relieving
pain and delaying surgical interference

23. approach
• the patient make a fist and at the same time
flex his or her wrist to aid in identification of
the palmaris longus tendon.
• needle is inserted just medial to the tendon
and just proximal to the crease of the wrist at
a 30-degree angle

24. Other Sites of Injections

25. TAKE HOME MESSAGE
• Injection is not the definitive treatment at all
• Do Not injury other important structure
• Steroids has no role in treatment of
Osteoarthritis
• Do Not Inject Inflammed Site
• Inject under Aseptic condition to avoid
causing more damage than the indication of
injection

26. Thank You