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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.

Coccyx Injections

Coccyx Injections

Coccyx pain (coccydynia) apparently occurs far less commonly than lumbosacral pain. Coccydynia can be a severe and persistent pain, causing significant suffering, frustration, and functional limitations (199). These patients often have a history of coccyx trauma (e.g., from a fall or childbirth) resulting in contusions, fractures, dislocations, or other injuries. However, other cases are idiopathic. Typical symptoms include focal tailbone pain, particularly worse with sitting and sometimes immediately worse upon going from sit-to-stand (199). Careful screening should seek to exclude…

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Metatarsal Joint Injection

Metatarsal Joint Injection

Tiếng Việt >> Indications This injection procedure is used to diagnose and treat Morton’s metatarsalgia and Morton’s neuroma. Techniques After informed consent is obtained, the patient is positioned for optimal access to the dorsal aspect of the foot. The metatarsal joint interspaces are palpated for swelling and tenderness. 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 1-in. (2-cm), 25-gauge needle…

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Discography (Diagnostic Disc Injection)

Discography (Diagnostic Disc Injection)

Although still controversial, discography (diagnostic intervertebral disc injection) is both an imaging study and a provocative physiologic study for determining whether an intervertebral disc is in fact a pain generator in a given patient (Table 68-7). Inserting a spinal needle into the center of the intervertebral disc and injecting contrast dye provides both physiologic information on whether a degenerative disc is painful and on anatomic features of the intervertebral disc. There is currently no other method to establish reliably whether…

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Metatarsophalangeal Joint Injection

Metatarsophalangeal Joint Injection

Tiếng Việt >> Indications Metatarsophalangeal joint injection is a useful procedure in the treatment of joint inflammation secondary to rheumatoid arthritis. Techniques After obtaining informed consent, the patient is positioned for optimal access to the dorsal surface of the foot. The metatarsophalangeal joints are palpated for swelling and point tenderness. 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. Light traction is…

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Sacroiliac Joint Injection

Sacroiliac Joint Injection

The sacroiliac (SI) joint can be a significant source of low back pain (141–143). Etiologies of SI pain include spondylo arthropathy, crystal arthropathy, septic arthritis, trauma, and pregnancy diasthesis (144). In addition, SI joint dysfunction (pain from a biomechanical disorder without a demonstrable lesion) has been proposed as a possible etiology of SI pain (145). Among patients with chronic low back pain, a study using a single block technique of the SI joint with a local anesthetic, estimated the prevalence…

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Plantar Heel Fascia Injection

Plantar Heel Fascia Injection

Tiếng Việt >> Indications Plantar heel fascia injection is used to treat inflammation at the insertion of the long plantar ligament at the anterior aspect of the calcaneus, secondary to chronic overuse disorder or spondyloarthritides. Techniques After informed consent is obtained, the patient is placed in the prone position with the feet extending over the end of the examination table. The plantar aspect of the heel is palpated in the area of the attachment of the plantar fascia to the…

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Radiofrequency Neurotomy for Z-joint Pain

Radiofrequency Neurotomy for Z-joint Pain

Radiofrequency neurotomy interrupts the nociceptive afferent from the Z-joint by thermally coagulating the two medial branches that innervate a given Z-joint. The exposed terminal portion of radiofrequency probe delivers heat at 80°C. For each Z-joint (except the C2-3 joint, which is innervated by the third occipital nerve), two medial branches need to be ablated. Indications Radiofrequency neurotomy can provide relative long-term benefit symptoms from persistent or recurrent Z-joint pain despite conservative care (that have had transient benefit from Z-joint injections),…

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Zygapophyseal Joint Injection

Zygapophyseal Joint Injection

Introduction The prevalence of lumbar zygapophyseal joint (Z-joint) pain has been reported to be approximately 6% in a primary care setting (94). However, in a tertiary spine center, lumbar Z-joint pain has been reported to range from 15% in younger individuals (96) to 40% in older populations (98) with chronic low back pain. In individuals with chronic neck pain after a whiplash injury, Z-joint pain occurred in approximately 50% of patients (99,100). More recent literature examining 500 patients has reported…

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Retrocalcaneal Bursa Injection

Retrocalcaneal Bursa Injection

Tiếng Việt >> Indications Retrocalcaneal bursa injection is a useful therapeutic procedure for bursitis secondary to repetitive overuse disorder or rheumatoid arthritis. Techniques After informed consent is obtained, the patient is situated in the side lying position. The lateral malleolus and the Achilles tendon 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 the procedure. A 1½-in. (4-cm), 23- to 25-gauge needle…

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Selective Nerve Root Block

Selective Nerve Root Block

Diagnostic Nerve Root Block Because of the overlap pattern of dermatomal innervation and the anatomic variants of spinal nerves, clinical history and physical examination alone are often not sufficient to accurately diagnose the segmental level of a spinal nerve lesion. In addition, current imaging studies and electrodiagnostic tests have limited sensitivity and specificity in reaching a conclusive diagnosis of radicular pain at a specific spinal level. Therefore, a diagnostic SNRB can be an important test with respect to providing a…

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