Injections Injections for the Upper Extremity Treatment Tortures, - - PowerPoint PPT Presentation

Injections for the Upper Extremity Tortures, Voodoo or Magic Bullet

• C. Benjamin Ma, MD

Professor in Residence Chief, Shoulder and Sports Medicine University of California, San Francisco Department of Orthopaedic Surgery

Injections

Treatment Anti-inflammatory Viscosupplementation Diagnostic Lidocaine injection Differential injection

• Multiple locations

Injections

Pearls Use the same size needle each time

• Get comfortable with the

resistance.

Don’t use a long long long needle

unless you have to

Volume is important, different

volume for different purpose

Injections

Shoulder Glenohumeral joint Bursa AC joint Biceps tendinitis Elbow Intra-articular Epicondylitis Wrist and Hand Intra-articular Trigger finger

Shoulder

Intra-articular (22G needle -

10ml)

Frozen shoulder Osteoarthritis Feel the soft spot posteriorly Aim for the coracoid process. Stay horizontal Best treatment for frozen

shoulder

Shoulder

Subacromial injection (22g needle

• 10ml)

Rotator cuff tears Impingement syndrome/bursitis Can do it posteriorly or laterally Go underneath the bone Very easy injection, no pressure. If it is hard to inject, think about

moving the needle as it may be in muscle

Shoulder

Acromioclavicular joint (1-2ml) AC joint arthritis Tough joint to inject Very superficial. Can feel the space between the acromion

and distal clavicle

Don’t go too deep, only 1, at most 2 cm. If too deep, injecting into the subacromial

space

Shoulder

Bicipital groove (1-2ml) Biceps tendinitis Feel the tender spot Go straight down Touch bone and back up slightly Should have very easy injection

and goes along the bicipital bursa

If tough to inject, maybe intra-tendinosus injection Advice patient the risk of rupture and restrict

lifting for first week

Elbow – hard!

Intra-articular (3-5ml) Osteoarthritis Osteochondritis dessicans Soft Spot Feel the other side for

swelling

Lateral side of the elbow Border of radial head, ulna

and lateral epicondyle

Elbow

Lateral epicondyle (1-2ml) Tennis elbow Medial epicondyle (1-2ml) Medial epicondylitis Inject site of maximum tenderness 1cm distal to the epicondyle Warn patient of Fat atrophy Hyper- or hypopigmentation Numbness of ulna nerve for medial epicondylitis Don’t use long-acting anesthetic!

Wrist and Hand

Intra-articular (2-3ml) Osteoarthritis Cartilage injuries (TFCC) Difficult – more technical Dorsal approach Extensor compartment (1-2ml) De Quervain’s syndrome

Trigger finger

Along tendon sheath

A1 pulley (1-2ml)

Small caliber needle 25g Go right at the point of

swelling and pain.

Withdraw to ensure not

in blood vessel

• C. Benjamin Ma

maben@orthosurg.ucsf.edu