"administer intra-articular injectate, usually a corticosteroid and a longer-acting local anaesthetic, i.e. ropivacaine."
"Pre-procedural evaluation"
"Relevant imaging should be reviewed and details of the patient confirmed. The patient should have an opportunity to discuss the risks and benefits and consent obtained."
"Driving is not advised after any injection, particularly if local anaesthetic is used. The reasons include an inability to perform an emergency procedure and be in safe control of a vehicle."
"In fluoroscopy, either an ‘eye of the needle’ approach can be used - parallel to the x-ray beam making the needle look like a dot, or an ‘oblique’ approach, which are out-of-plane with the x-ray beam, and the needle will look like a line. In ultrasound-guided procedures, the needle should be visualised entering the joint 2."
"Syringe selection for the anaesthetic arthrogram injectate will be based upon the size of the joint and total injectate to be administered. Luer lock syringes are recommended in smaller joints as they can be under pressure. Suggested volumes of local anaesthetic for different joints are suggested below:"
"Needle selection will depend on the depth and size of the joint. Smaller gauge needles can be less painful, but when used to reach deeper joints are less stiff and can bend. Suggested needles for different joints are below -"
"Needle selection will depend on the depth and size of the joint. Smaller gauge needles can be less painful, but when used to reach deeper joints are less stiff and can bend. Suggested needles for different joints are below -"
"5 mL syringe: 40mg triamcinolone acetonide (40 mg/1 mL) and 3 mL 0.5% ropivacaine"
"triamcinolone acetonide (e.g. Kenalog TM, Volon A)"
"ACJ/ subtalar: 1 mL"
"ACJ/ subtalar: 25 or 27-gauge needles"
Expected headings
"Absolute"
"Relative"
"Pre-procedural evaluation"
"Imaging modalities"
"Syringe selection"
"Common corticosteroid medications"
"Anaesthetic arthrogram injectate"
"Needle selection"
"triamcinolone acetonide (e.g. Kenalog TM, Volon A)"
"methylprednisolone acetate (e.g. Medrol)"
"The named steroids are 1 mL in volume, i.e. 40 mg triamcinolone acetonide (40 mg/1 mL). There are documented cases of adverse events after anaesthetic arthrogram injections with corticosteroids which include accelerated osteoarthritis progression, subchondral insufficiency fracture, and loss of bone density 3. Further research is required in this area, but the frequency and dose of these injections should be considered when protocolling and performing in all intra-articular steroid injections."
"There are reported chondrotoxic effects of local anaesthetics, and intra-articular lidocaine should be avoided. Other lower strength local anaesthetics are reported as having less of a chondrotoxic effect. i.e. ropivacaine 4."
"1st CMCJ/ TMTJs/ 1st MTPJ: 25, 27 or 30-gauge needles"