Table Of ContentInjection Procedures
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Todd P. Stitik
Editor
Injection Procedures
Osteoarthritis and Related Conditions
Editor
Todd P. Stitik
Professor, Physical Medicine and Rehabilitation
Co-Director, Musculoskeletal/Pain Management Fellowship
Director, Occupational/Musculoskeletal Medicine
Co-Director, Interventional Spine Injection Clinic
Department of Physical Medicine and Rehabilitation
New Jersey Medical School
Newark, NJ, USA
[email protected]
ISBN 978-0-387-76594-5 e-ISBN 978-0-387-76595-2
DOI 10.1007/978-0-387-76595-2
Springer New York Dordrecht Heidelberg London
Library of Congress Control Number: PCN applied for
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Springer is part of Springer Science+Business Media (www.springer.com)
I dedicate this book to my wife, Rossana,
and children, Jeanette (“Jenna”) and Luke,
whose patience, understanding, sacrifice,
and support were greatly appreciated and
necessary for the project to be completed.
Without them in my life, this book would not
have been written.
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Preface
It has been my belief, ever since I was a resident physician and performed my first
musculoskeletal injection procedure (a carpal tunnel injection for a patient whom I
had diagnosed by EMG testing with carpal tunnel syndrome), that better instruc-
tional material was needed for musculoskeletal medicine injection procedures. I
recall in preparing for that injection that I had to refer to several different sources
of information. Despite this, not one source adequately explained the entire proce-
dure in a practical step-by-step fashion that also included helpful clinical pearls and
pitfalls, and none of the sources provided me with a template that I could use to
document the procedure in the medical record. The patient’s gratitude when the
injection subsequently greatly relieved his symptoms helped to convince me that I
wanted to develop a musculoskeletal medicine practice with an emphasis on office-
based injection procedures.
After struggling to learn and perform several other injection procedures while I
was still a resident, I began to wonder why office-based musculoskeletal medicine
injection procedures in general were not being performed at that time using some
form of image guidance. It was my belief that image guidance could help with
injection accuracy and that this would likely translate into better clinical results and
help to minimize patient’s discomfort and side effects. It is hard to prove with cer-
tainty for most procedures that the increased accuracy associated with image guid-
ance compared to blind injection procedures results in better outcomes. However it
is tough to deny that an image-guided injection procedure, that does not result in
pain relief, more convincingly excludes the structure as a pain generator compared
to lack of a beneficial response after a nonimage-guided injection.
When I began to teach musculoskeletal medicine, I quickly learned to enjoy the
inevitable look of interest on the faces of the students, residents, and fellows when
they witnessed a particular injection procedure for the first time. This interest is
then usually replaced with a look of satisfaction and sometimes exhilaration when
they eventually successfully perform a procedure themselves.
I also found that good and sometimes detailed procedural documentation is very
important with respect to patient care (particularly for repeat procedures since a
procedure note that documents any nuances encountered during a procedure will
usually help guide future procedures on the same patient) and reimbursement and
can be helpful in situations of alleged malpractice. However, any busy clinician can
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viii Preface
relate to the dilemma that is often posed by the desire to adequately document a
procedure and the reality of significant time limitations.
Through these experiences with learning, performing, and then teaching muscu-
loskeletal medicine injection procedures, I decided to someday attempt to write a
comprehensive injection textbook with an emphasis on image guidance. When I
finally and firmly committed to undertaking this project, it was clear to me that the
field of musculoskeletal medicine was rapidly moving in the direction of image
guidance as a tool for improving injection procedures. During the subsequent years
during which this book has been written, the trend of image guidance has acceler-
ated even more, particularly with the advent of musculoskeletal ultrasound into
mainstream medicine in the USA. This trend further convinced me of the need for
a text that emphasized image guidance.
In summary, this musculoskeletal medicine injection text has several purposes:
to discuss as many of the different procedures as possible, reference the literature,
instruct the physician in a step-by-step manner on how to perform the injection
using images (not just drawings) from procedures performed on actual or simulated
patients wherever possible, teach useful clinical pearls and warn of pitfalls, and
provide ready-made documentation templates that could be adapted to a given clini-
cal practice for the medical record. It was therefore my overall goal that this book
would be much more than just an instructional manual on how to perform an injec-
tion. I hope that this has been achieved.
Newark, NJ Todd P. Stitik
Acknowledgments
The following pharmaceuticals are often cited in the Procedure Instructions and the
Injection Procedure Templates in Chaps. 6–12. As a space-saving device, the manu-
facturer, city, state/province, country are noted herewith instead of in the Instructions
and Templates:
Betadine® (Purdue-Pharma LP, Stamford, CT, USA)
Depo-Medrol® (Pfizer, New York, NY, USA)
MyoJect™ (VIASYS Healthcare, San Diego, CA, USA)
Omnipaque™ (GE Healthcare, Waukesha, WI, USA)
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