Summary

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After an injection, you should remind your patients:

  • To avoid strenuous exercise, but recommend to continue their routine daily activities, for the next two to three days.

  • To consider icing the area for 20-minute intervals as needed for discomfort.

  • That they may experience a post-steroid flare, which is an INCREASE in pain for the first 24 to 48 hours after an injection. Reassurance and education is usually all that is needed to treat this complication. Oral NSAIDs and ice may also be recommended.

  • If redness or an increase in pain lasting more than 72 hours develops after the injection, re-evaluation for a septic joint should occur.

The following is a summary of the supplies needed for each anatomic site discussed in this module.

Injection Site: Knee

  • Syringe size: 5 - 10cc

  • Needle gauge: 22

  • Needle length: 1.5-inch

  • Anesthetic: 3 - 5cc

Injection Site: Subacromial Bursa

  • Syringe size: 10cc

  • Needle gauge: 21 - 25

  • Needle length: 1.5-inch

  • Anesthetic: 5cc

Injection Site: Carpal Tunnel

  • Syringe size: 5cc

  • Needle gauge: 21 - 25

  • Needle length: 1.5-inch

  • Anesthetic: 2 - 3cc

Injection Site: Greater Trochanter Bursa

  • Syringe size: 5 - 10cc

  • Needle gauge: 22 - 25

  • Needle length: varies

  • Anesthetic: 4cc

Injection Site: Lateral Epicondylitis

  • Syringe size: 5cc

  • Needle gauge: 25

  • Needle length: 1-inch

  • Anesthetic: 2 - 3cc

Injection Site: First MTP/CMC

  • Syringe size: 3cc

  • Needle gauge: 25 - 26

  • Needle length: 1-inch

  • Anesthetic: 0.5 - 1cc

Injection Site: de Quervain's Tenosynovitis

  • Syringe size: 5cc

  • Needle gauge: 25

  • Needle length: 1.5-inch

  • Anesthetic: 1cc

Key Points:

  • Joint injections are routinely performed about every three to four months.

    • There is no data to support that more frequent injections are harmful, but the standard of care is to limit the amount of steroid injections per osteoarthritic joint to no more than three to four times per year for the lifetime of the joint.

  • There are varying grades of evidence to support the efficacy of each type of joint or soft tissue injection.

  • Joint and soft tissue injections are safe and can be easily mastered by most primary care physicians.

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