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High Impact Rheumatology Joint Examination and Injection Techniques Part 1: Upper Extremities.

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Page 1: High Impact Rheumatology Joint Examination and Injection Techniques Part 1: Upper Extremities.
Page 2: High Impact Rheumatology Joint Examination and Injection Techniques Part 1: Upper Extremities.

High Impact Rheumatology

Joint Examination and Injection Techniques Part 1: Upper Extremities

Page 3: High Impact Rheumatology Joint Examination and Injection Techniques Part 1: Upper Extremities.

Injections

• Steroids, soluble and insoluble • Triamcinolone hexacetonide (Aristospan)• Triamcinolone acetonide (Kenalog)• Methylprednisolone acetate (DepoMedrol)• Dexamethasone (Decadron)

• Local anesthetics • Bupivacaine (Marcaine)• Lidocaine (Xylocaine)

Page 4: High Impact Rheumatology Joint Examination and Injection Techniques Part 1: Upper Extremities.

Cautions About Injections Disinfect injection site Wear gloves for your own protection Don’t inject through cellulitis or psoriatic skin lesion Use a large-gauge needle to aspirate an inflamed

or infected joint Use small-gauge needle and hold pressure over

injection site if patient is anticoagulated Do not inject the same joint more than 3 to 4 times

a year Some steroid will be absorbed systemically and

can worsen CHF, HTN, and DM

Page 5: High Impact Rheumatology Joint Examination and Injection Techniques Part 1: Upper Extremities.

Anterior Shoulder Exam Sternoclavicular joint Acromioclavicular joint Glenohumeral joint Biceps tendon

Page 6: High Impact Rheumatology Joint Examination and Injection Techniques Part 1: Upper Extremities.

Supraspinatus tendon Infraspinatus tendon Teres minor tendon

Rotator Cuff Exam

Page 7: High Impact Rheumatology Joint Examination and Injection Techniques Part 1: Upper Extremities.

Insert needle 1 cm below coracoid process

Medial to humeral head

Shoulder Joint Injection

Page 8: High Impact Rheumatology Joint Examination and Injection Techniques Part 1: Upper Extremities.

Localize lateral midpoint of acromion

Insert 1 cm distal Angle needle upward

Subdeltoid Bursa Injection

Page 9: High Impact Rheumatology Joint Examination and Injection Techniques Part 1: Upper Extremities.

Lateral epicondyle at insertion of common extensor tendon

Olecranon bursa Lateral joint line

between humerus and proximal ulna for synovial swelling or effusion

Elbow Exam

Page 10: High Impact Rheumatology Joint Examination and Injection Techniques Part 1: Upper Extremities.

Elbow Joint Injection Midpoint of line

between lateral epicondyle and tip of the olecranon

Angle needle toward middle of antecubital fossa

Keep elbow at 90 degrees

Page 11: High Impact Rheumatology Joint Examination and Injection Techniques Part 1: Upper Extremities.

Palpate over proximal ulna

Olecranon Bursa

Page 12: High Impact Rheumatology Joint Examination and Injection Techniques Part 1: Upper Extremities.

Lateral epicondyle

Elbow Injections

Elbow joint injection

Page 13: High Impact Rheumatology Joint Examination and Injection Techniques Part 1: Upper Extremities.

Support wrist in 15-degree flexion

Palpate radiocarpal joint and ulnocarpal joint

Keep extensor tendons relaxed

Wrist Exam

Page 14: High Impact Rheumatology Joint Examination and Injection Techniques Part 1: Upper Extremities.

Wrist in 15-degree flexion

Insert needle next to extensor tendon of the thumb

Angle slightly toward distal ulna

Wrist Injection

Page 15: High Impact Rheumatology Joint Examination and Injection Techniques Part 1: Upper Extremities.

Support palm of hand Palpate both sides of

the joint line with thumbs

Metacarpophalangeal Joints

Page 16: High Impact Rheumatology Joint Examination and Injection Techniques Part 1: Upper Extremities.

Palpate both lateral joint lines with thumb and index finger while palpating volar and palmar sides with opposite thumb and finger

Finger Exam

Page 17: High Impact Rheumatology Joint Examination and Injection Techniques Part 1: Upper Extremities.

Finger Joint Injection 15-degree flexion Insert needle at

“2 o’clock” just into the capsule

Page 18: High Impact Rheumatology Joint Examination and Injection Techniques Part 1: Upper Extremities.
Page 19: High Impact Rheumatology Joint Examination and Injection Techniques Part 1: Upper Extremities.

High Impact Rheumatology

Joint Examination and Injection Techniques Part 2: Lower Extremities

Page 20: High Impact Rheumatology Joint Examination and Injection Techniques Part 1: Upper Extremities.

Injections

• Steroids, soluble and insoluble • Triamcinolone hexacetonide (Aristospan)• Triamcinolone acetonide (Kenalog)• Methylprednisolone acetate (DepoMedrol)• Dexamethasone (Decadron)

• Local anesthetics • Bupivacaine (Marcaine)• Lidocaine (Xylocaine)

Page 21: High Impact Rheumatology Joint Examination and Injection Techniques Part 1: Upper Extremities.

Cautions About Injections

Disinfect injection site Wear gloves for your own protection Don’t inject through cellulitis or psoriatic skin

lesion Use a large-gauge needle to aspirate an

inflamed or infected joint Use small-gauge needle and hold pressure over

injection site if patient is anticoagulated Do not inject the same joint more than 3 to 4

times a year Some steroid will be absorbed systemically and

can worsen CHF, HTN, and DM

Page 22: High Impact Rheumatology Joint Examination and Injection Techniques Part 1: Upper Extremities.

Hip Region Exam Trochanteric bursa Femoral-acetabular joint

Page 23: High Impact Rheumatology Joint Examination and Injection Techniques Part 1: Upper Extremities.

Hip Joint Injection

Lateral approach to hip

Direct injection

Page 24: High Impact Rheumatology Joint Examination and Injection Techniques Part 1: Upper Extremities.

Knee Joint Exam Palpate synovial reflection at inferomedial and inferolateral

margins of patella

Page 25: High Impact Rheumatology Joint Examination and Injection Techniques Part 1: Upper Extremities.

Prepatellar Bursa

Palpate anterior surface of patella

Page 26: High Impact Rheumatology Joint Examination and Injection Techniques Part 1: Upper Extremities.

Knee Injection

Knee fully extended Junction upper third

and lower two thirds of the patella

Insert needle under patella and aim superiorly

© ACR

Page 27: High Impact Rheumatology Joint Examination and Injection Techniques Part 1: Upper Extremities.

Ankle Exam For tibiotalar joint,

palpate 1 cm anterior to distal medial malleolus just medial to extensor tendon and palpate anterior to distal fibula

Page 28: High Impact Rheumatology Joint Examination and Injection Techniques Part 1: Upper Extremities.

Ankle Joint Injection Insert needle 1 cm

anterior to distal medial malleolus, just medial to dorsalis pedis pulse and extensor tendon of great toe

Page 29: High Impact Rheumatology Joint Examination and Injection Techniques Part 1: Upper Extremities.

Lateral Foot Exam Calcaneocuboid joint

is 2 cm distal to fibula and 1 cm anterior

Page 30: High Impact Rheumatology Joint Examination and Injection Techniques Part 1: Upper Extremities.

Medial Foot Exam Palpate talonavicular

joint2 cm anterior to distal medial malleolus

Page 31: High Impact Rheumatology Joint Examination and Injection Techniques Part 1: Upper Extremities.

Metatarsophalangeal Exam

Palpate MTP joint with second and third fingers on plantar surface while stabilizing joint with thumb on anterior surface

Page 32: High Impact Rheumatology Joint Examination and Injection Techniques Part 1: Upper Extremities.

Interpharyngeal Joints of Toes Palpate lateral sides of

joint line with thumb and index finger

Palpate anterior and plantar surfaces with thumb and index finger of opposite hand


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