Exam amp Injection Pearls Hindson Foundation联合考试amp注射珍珠汉森的基础课件.ppt

Exam amp Injection Pearls Hindson Foundation联合考试amp注射珍珠汉森的基础课件.ppt

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Exam amp Injection Pearls Hindson Foundation联合考试amp注射珍珠汉森的基础课件

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Note tissue thickness medial vs lateral * Note ridge on lateral femur * Note concave v convex relationship of PFJ * * * Patella Medial edge of patellar ligament Tibial plateau This approach can be done from either the medial or lateral surface Identify the patellar ligament then the tibial plateau Generally there is a “soft spot” that identifies the area adjacent to the ligament and just above the tibial plateau Angle the needle toward the center of the knee Anterior approaches for knee injections Anterior approach “Soft spot” Needle directed toward center of knee Not recommended for aspiration Lateral Midpatellar Approach Remember MRI scan Suggest inserting needle no further than 1/2 the way down the lateral patellar margin Tissue to traverse is thin laterally and can use 1” needle in normal sized person John Clark is using butterfly needle in this picture John Clark MD, PhD Bilateral knee effusions Note loss of medial concavity and bulging suprapatellar pouch Anesthesia with 1-2% lidocaine without epinephrine (what is wrong with this picture?) Note marks on knee Aspiration with 21-22 gauge needle and 20-30 cc syringe Using mosquito clamp to change from aspiration to injection syringe Injecting with 40 mg of triamcinolone or depomedrol +/- mixed with small amount of local anesthetic Clean, bandage, bed rest x 24 hr Accuracy of knee injection into non-effused joints by location of injection 240 knee injected for OA done by one orthopaedic surgeon into knees without effusions Three approaches; anteromedial, anterolateral, and lateral mid-patellar Placement of injected material confirmed by fluoroscopy Accuracy: Anteromedial: 60/80 in joint space (75% accuracy) Anterolateral: 57/80 in joint space (71% accuracy) Lateral mid-patellar: 74/80 in joint space (93% accuracy) Jackson et al. JBJS 2002;84-A:1522-27 Aspirate or not aspirate RA knee before steroid injection? 191 swollen RA knees rando

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