Atlas of Injection Therapy in Pain Management

193 Pages·2011·24.74 MB·English

by  Juergen Fischer

F Atlas of Injection Therapy
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A highly eff ective, low-risk pain management
therapy to include in your patient services
Atlas of Injection Therapy in Pain Management provides a practical, step-by-step A Juergen Fischer
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approach that will allow physicians, including those without extensive prior experience, l
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to manage pain through the injection of local anesthetics. Its clear, symptom-oriented s

format and detailed directions show how to recognize clinically recurring pain patterns, o
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administer the correct treatment, and manage pain syndromes successfully. I
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Special Features: c
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• Precise instructions for implementing injection techniques safely and effi ciently— i
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even for more complex pain such as headache and in the shoulder n

• Nearly 100 clear anatomic illustrations that use a simple color key to demonstrate T
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injection points and areas of pain distribution—an ideal visual learning aid
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• Concise descriptions of indications; diff erential diagnoses; materials and r
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techniques; insertion points, direction and depth; possible risks and side eff ects; p
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and concomitant therapies for pain treatment
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• A straightforward double-page format with text on one side and anatomic n

drawings on the facing page for easy mastery of techniques P
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For all busy clinicians whose aim is to relieve pain quickly and eff ectively—and add
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a valuable, cost-eff ective service to their practice—this atlas-style teaching reference
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is essential. Orthopedists, sports medicine physicians, physical therapists, and n
a
practitioners of manual medicine will fi nd a wealth of information and a “roadmap”
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of techniques that can be seamlessly integrated into everyday practice. e
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Juergen Fischer, MD, is Professor and Specialist in Orthopedics and Trauma Surgery, n
Orthopedic Center Luisenplatz, Darmstadt, Germany. t
An award-winning international medical and scientifi c publisher, Thieme has
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ISBN 978-3-13-154301-1
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FrauKurz Feuchtwangen AtlasofInjectionTherapy… TN154301 Fischer_Titelei
Thieme-Verlag SOMMERmedia Fischer.: WN026899/01/01 22.6.2011
FrauKurz Feuchtwangen AtlasofInjectionTherapy… TN154301 Fischer_Titelei
Thieme-Verlag SOMMERmedia Fischer.: WN026899/01/01 22.6.2011
FrauKurz Feuchtwangen AtlasofInjectionTherapy… TN154301 Fischer_Titelei
Atlas of Injection
Therapy in Pain Management
Juergen Fischer, MD
Professor
SpecialistinOrthopedicsandTraumaSurgery
OrthopedicCenterLuisenplatz
Darmstadt,Germany
95illustrations
Thieme
Stuttgart·NewYork
Thieme-Verlag SOMMERmedia Fischer.: WN026899/01/01 22.6.2011
FrauKurz Feuchtwangen AtlasofInjectionTherapy… TN154301 Fischer_Titelei
IV
LibraryofCongressCataloging-in-PublicationData Importantnote:Medicineisanever-changingscience
undergoingcontinualdevelopment.Researchandclini-
Fischer,Jürgen,MD. cal experience are continually expanding our knowl-
[SchmerztherapiemitLokalanästethika.English] edge,inparticularourknowledgeofpropertreatment
Atlasofinjectiontherapyinpainmanagement:injec- and drug therapy. Insofar as this book mentions any
tiontechniquessimpleandsafe/JuergenFischer. dosageorapplication,readersmayrestassuredthatthe
p.;cm. authors,editors,andpublishershavemadeeveryeffort
Includesbibliographicalreferencesandindex. to ensure that such references are in accordance with
ISBN978-3-13-154301-1(alk.paper) the state of knowledge at the time of production of
1.Injections,Intra-articular–Atlases.2.Joints–Diseases– thebook.
Chemotherapy–Atlases.I.Title. Nevertheless,thisdoesnotinvolve,imply,orexpressany
[DNLM: 1.Pain–drug therapy–Atlases. 2.Anesthetics, guaranteeorresponsibilityonthepartofthepublishers
Local–therapeuticuse–Atlases.3.Injections–methods– inrespecttoanydosageinstructionsandformsofappli-
Atlases.WL17] cations stated in the book. Every user is requested to
RC925.5.F572011 examine carefully the manufacturers’ leaflets accom-
616'.0472–dc23 panyingeachdrugandtocheck,ifnecessaryinconsulta-
2011018960 tionwithaphysicianorspecialist,whether thedosage
schedules mentioned therein or the contraindications
statedbythemanufacturersdifferfromthestatements
Thisbookisanauthorizedtranslationofthe madeinthepresentbook.Suchexaminationisparticu-
2ndGermaneditionpublishedandcopyrighted2010 larlyimportantwithdrugsthatareeitherrarelyusedor
byGeorgThiemeVerlag,Stuttgart.TitleoftheGerman havebeennewlyreleasedonthemarket.Everydosage
edition:SchmerztherapiemitLokalanästhetika. scheduleoreveryformofapplicationusedisentirelyat
Injektionstechniken–einfachundsicher. theuser’sownriskandresponsibility.Theauthorsand
publishersrequesteveryusertoreporttothepublish-
ersanydiscrepanciesor inaccuraciesnoticed.Iferrors
inthisworkarefoundafterpublication,erratawillbe
Translator:RuthGutberlet,Cochem,Germany postedatwww.thieme.comontheproductdescription
page.
Illustrator:ChristineLackner,Ittlingen;PeterHaller,
Stuttgart;HolgerVanselow,Stuttgart,Germany
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Dedicated to my children
Kai and Nicole
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FrauKurz Feuchtwangen AtlasofInjectionTherapy… TN154301 Fischer_Titelei
VI
Preface
Painisthemostfrequentcauseforpatient–physi- patterns emerge. The typical clinical pain pattern
cian contact. The patient expects rapid relief and allows exact assignment of a suitable injection
freedom from pain. The more efficient the relief, treatment.
themoresuccessfulthephysicianisfelttobe. In this book, physicians will find symptom-
Besides elimination of pain-producing causes, oriented“cookbook-style”directions,whichprovide
eliminationof pain itself is the ultimate ambition easy recognition and indication of the approach.
oftherapy.Thisshouldtakeplacerapidly,withfew Both circumscribed pain of singular origin and
sideeffects,simply,andatlittlecost. complex pain syndromes can be managed effec-
Paintreatment through local anesthetics is one tivelyandrapidly.
ofthemostefficientandfastest-actingpaintreat- Owingtothegreatnumberofdidacticalillustra-
ment options. A prerequisite is knowledge of the tions,itispossibletoperforminjectiontreatments
exact techniques and indications, as well as the withlittleprecedingexperience.Risksarediscern-
risks. Injections are invasive procedures and ableinregardtotechniqueandlocationandcon-
requirepreciseexecution.Painsymptomsandpat- comitant treatments are listed. This enables the
terns encountered in daily practice are manifold practitionertoridthepatientofpaininafast,effi-
andoftendifficulttoassociatecausally.Amongthe cient,andlow-riskmanner.
various pain patterns that present themselves in
daily practice, some typical, constantly recurring JuergenFischer
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VII
Contents
1 Introduction 2
PhysiologyofPainDevelopment ........ 2 EffectsofLocalAnesthetics ............ 6
TherapeuticPossibilities .............. 3 InjectionTechniques ................. 6
MethodsforApplicationofLocal SideEffectsandContraindications
Anesthetics ......................... 3 ofTreatmentswithLocalAnesthetics .... 9
2 Head 12
ComplexPain ...................... 12 Temporalis...................... 22
Temporal/ParietalHeadache ........ 12 MasseterandMandibularJoint ...... 24
OccipitoparietalHeadache ......... 14
TreatmentthroughNerves............ 26
ParietalLock .................... 16 SupraorbitalNerve ............... 26
OccipitalHeadache ............... 18 InfraorbitalNerve ................ 28
PainintheRegionoftheEar ........ 20
TreatmentthroughtheSkin........... 30
TreatmentthroughMuscles,Tendons, “CrownofThorns” ................ 30
andLigaments ..................... 22
3 CervicalSpine 32
ComplexPain ...................... 32 RectusCapitisPosteriorMajor
NonspecificNeckPain ............. 32 andMinor ...................... 42
InterspinousNeoarthrosis/Irritation TreatmentthroughNerves............ 44
oftheInterspinales ............... 34
GreaterandLesserOccipitalNerve ... 44
TreatmentthroughMuscles,Tendons, TreatmentthroughJoints ............. 46
andLigaments ..................... 36 CervicalVertebralJointsoftheC4–C6
LevatorScapulae ................. 36
Segments ....................... 46
Sternocleidomastoid .............. 38
Trapezius ....................... 40
4 UpperExtremities 48
ComplexPain ...................... 48 Supraspinatus ................... 60
AnteriorShoulderandSubacromial Infraspinatus .................... 62
Pain ........................... 48 BicepsBrachii ................... 64
PainintheAreaoftheCoracoidProcess 50 TricepsBrachii ................... 66
LateralEpicondylitis(TennisElbow) .. 52 Supinator ....................... 68
MedialEpicondylitis(Golfer’sElbow) . 54 TriggerFinger.................... 70
TherapythroughMuscles,Tendons, PainintheAreaoftheRadialStyloid
andLigaments ..................... 56 Process ......................... 72
Deltoid ......................... 56 PainintheAreaoftheUlnarStyloid
Process ......................... 74
Rhomboid ...................... 58
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VIII Contents
TenosynovitisStenosans ........... 76 ElbowJoint(Humeroradial/
HumeroulnarJoint) ............... 84
TherapythroughNerves ............. 78
Wrist(RadiocarpalJoint) ........... 86
SuprascapularNerve .............. 78
RhizarthrosisandPainSyndromes
MedianNerve ................... 80
oftheThumbSaddleJoint .......... 88
Intra-articularTherapy............... 82
ShoulderJoint(GlenohumeralJoint).. 82
5 ThoraxandAbdomen 90
ComplexPain ...................... 90 TherapythroughtheSkin ........... 102
Xiphoid–Sternum–ClavicleTriangle .. 90 DisordersoftheStomach
InterscapularPain ................ 92 andtheDuodenum .............. 102
PancreaticPainSyndrome ......... 104
TherapythroughMuscles,Tendons,
KidneysandUrinaryTract......... 106
andLigaments ..................... 94
OvariesandFallopianTubes ....... 108
PectoralisMajor.................. 94
Sternocostalis ................... 96 Dysmenorrhea .................. 110
RectusAbdominis ................ 98 LiverandGallbladderPain......... 112
TransversusAbdominis ........... 100
6 LumbarSpineandPelvis 114
ComplexPain ..................... 114 PainfulLongBackExtensors
Lumbago ...................... 114 (Longissimus,Iliocostalis) ......... 122
PiriformisSyndrome ............. 116 TherapythroughNerves ............ 124
PeriarthritisCoxae............... 118 ObturatorNerve ................ 124
TherapythroughMuscles,Tendons, LateralFemoralCutaneousNerve ... 126
andLigaments .................... 120
TherapythroughJoints.............. 128
Adductors ..................... 120
LumbarVertebralJoints........... 128
7 LowerExtremities 130
ComplexPain ..................... 130 InfrapatellarNerve .............. 146
PatellofemoralPainSyndrome TarsalTunnelandTibialisPosterior
(Runner’sKnee) ................. 130 Compartment .................. 148
GracilisandPesAnserinusPain InterdigitalNerve(MortonNeuroma) 150
Syndromes ..................... 132 CalcaneusPain .................. 152
TherapythroughMuscles,Tendons, TherapythroughtheSkin ........... 154
andLigaments .................... 134 KneeCircle..................... 154
BicepsFemoris.................. 134 MedialMeniscusPain ............ 156
QuadricepsFemoris .............. 136 LateralMeniscusPain ............ 158
TricepsSurae ................... 138 PainalongtheTibia .............. 160
Peronei........................ 140
TherapyandJointInjection .......... 162
MedialCollateralLigament ........ 142
HipJoint....................... 162
LateralCollateralLigament ........ 144
KneeJoint ..................... 164
TherapythroughNerves ............ 146
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Contents IX
UpperAnkleJoint(Talocrural MetatarsalPhalangealJoint ........ 168
Articulation) ................... 166
8 MyofascialPainSyndromes 170
FrontoparietalDysfunctionSyndromes . 170 OccipitofrontalDysfunctionSyndromes 172
FurtherReading 174
Index 176