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Category: Injection Procedures

The injection procedures outlined in this chapter are appropriately used in conjunction with other aspects of rehabilitation to reduce pain and increase function. Sterile technique and knowledge of anatomic relationships are required. Aspiration is performed before injecting and is repeated as necessary throughout administration of medication to prevent intravascular injection. For optimal results and safety with injection techniques, the practitioner needs the necessary skill, training, and education to perform the procedures. Haste and failure to observe the necessary precautions by the practitioner increase the risks for any procedure. Knowledge of the anatomy pertaining to each injection procedure is a requirement for safe and successful outcomes in even the simplest injection.

Epidural Steroid Injection

Epidural Steroid Injection

Epidural steroid injections (ESIs) for the management of lumbar radicular pain provide the advantage of delivering potent anti-inflammatory agents in a localized fashion to the area of affected nerve roots, thereby decreasing the systemic side effects often seen with orally administered steroids. Lumbar ESIs have been endorsed by the North American Spine Society (2) and the Agency for Health Care Policy and Research (3) as an integral part of nonsurgical management of radicular pain from lumbar spine disorders. Cervical and…

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Coccygeal Junction Injection

Coccygeal Junction Injection

Indication Infiltration of the coccyx region can be useful as a therapeutic procedure in coccydynia after exclusion of infection or other significant pathology. Techniques After informed consent is obtained, the patient is positioned in the lateral Sims’ position with the left side down for right-handed clinicians. With the upper leg flexed, the buttocks are separated, allowing easy access to the sacrococcygeal junction. The patient is prepared in a standard aseptic fashion over an area large enough to allow palpation of…

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Sacroiliac Joint Injection

Sacroiliac Joint Injection

Indications Sacroiliac joint injection is used to treat inflammation of the sacroiliac joints secondary to trauma, rheumatoid arthritis, degenerative joint disease, or stress secondary to mechanical changes in posture or gait. Techniques After informed consent is obtained, the patient is placed in the prone position. The patient is prepared in a standard aseptic fashion over an area large enough to allow palpation of landmarks, and sterile technique is used throughout the procedure. A 6-in. (16-cm), 22-gauge needle is inserted. The…

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Lumbar Zygapophyseal Joint Injection

Lumbar Zygapophyseal Joint Injection

Indications The lumbar zygapophyseal (facet) joints have been shown to be a potential source of pain involving the low back and buttocks. Facet joint injections can provide diagnostic as well as therapeutic benefits for patients with low back pain. Techniques After informed consent is obtained, the patient is placed in the prone position with a pillow under the pelvis to flatten the lumbar curve. The lumbar spine is palpated for the point of maximum tenderness. The patient is prepared in…

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Interphalangeal Joint Injection

Interphalangeal Joint Injection

Tiếng Việt >> Indications Interphalangeal joint injection is used as a therapeutic procedure to treat inflammation of the metacarpal phalangeal and interphalangeal joints due to rheumatoid arthritis and other inflammatory arthritides. Techniques After informed consent is obtained, the patient is placed in the sitting position with the arm resting on the examination table. The hand is placed with the joint extended for approach from the lateral or medial aspect, with slight traction applied to the finger. The patient is prepared…

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First Metacarpal Joint Injection

First Metacarpal Joint Injection

Tiếng Việt >> Indications First metacarpal joint injection is used to treat pain and inflammation secondary to osteoarthritis. Techniques After informed consent is obtained, the patient is placed in a sitting position with the arm resting on the examination table. The forearm is placed on the ulnar side midway between supination and pronation, with the thumb adducted and held in flexion with the palm. The first metacarpal along the dorsal aspect to the groove at its proximal end is palpated….

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Abductor Tendon Injection of the Thumb

Abductor Tendon Injection of the Thumb

Indications Abductor tendon of the thumb injection is a useful therapeutic procedure for tenosynovitis of extensor pollicis brevis and abductor hallicus longus (de Quervain’s syndrome) usually associated with repetitive trauma disorder. This procedure involves injection of common tendon sheath of the long abductor and short extensor tendons of the thumb. Techniques After informed consent is obtained, the patient is placed in the sitting position with the arm resting on the examination table. The forearm is placed on the ulnar side…

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Wrist Joint Injection

Wrist Joint Injection

Tiếng Việt >> Indications Wrist joint injection is a useful diagnostic and therapeutic procedure for inflammation due to rheumatoid arthritis and other inflammatory arthritides. Techniques After informed consent is obtained, the patient is placed in the sitting position with the arm resting on the examination table. The hand is placed palm down with the wrist positioned over a rolled towel. The wrist joint is approached from the dorsal aspect. The patient is prepared in a standard aseptic fashion over an…

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Carpal Tunnel Injection

Carpal Tunnel Injection

Tiếng Việt >> Indications Injection of the carpal tunnel is used to treat inflammation of the tissue of the tunnel resulting in median nerve entrapment. Techniques After informed consent is obtained, the patient is placed in the sitting position with the arm resting on the examination table. The wrist is positioned with the hand dorsiflexed over a towel. The injection site is on the volar wrist surface just proximal to the distal wrist crease between the palmaris longus and flexor…

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Radiohumeral Joint (True Elbow Joint) Injection

Radiohumeral Joint (True Elbow Joint) Injection

Tiếng Việt >> Indications Radiohumeral joint injection is used to diagnose and treat the painful and swollen elbow due to rheumatoid arthritis or nonspecific inflammatory arthritides. Techniques After informed consent is obtained, the patient is placed in the sitting position with the elbow flexed to 90 degrees. The lateral epicondyle and posterior olecranon are palpated. The patient is prepared in a standard aseptic fashion over an area large enough to allow palpation of landmarks, and sterile technique is used throughout…

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