Injection Techniques in Orthopaedics and Sports Medicine: A Practical Manual for Doctors and Physiotherapists - 3rd Edition

203 Pages·2006·11.85 MB·English

by  Stephanie Saunders FCSP FSOM

INJECTION
TECHNIQUES
in Orthopaedic
and Sports Medicine
A practical manual for doctors
and physiotherapists
Dedication
In memory of Peter - my generous partner and best friend.
For Elsevier:
Senior Commissioning Editor: Sarena Wolfaard
Development Editor: Claire Wilson
Project Manager: Caroline Horton, Morven Dean
Design: George Ajayi
Illustration Manager: Bruce Hogarth
Illustrator: Amanda Williams
INJECTION
TECHNIQUES
in Orthopaedic and
Sports Medicine
A practical manual for doctors
and physiotherapists
THIRD EDITION
Stephanie Saunders
FCSP FSOM
Private Practitioner; Course Director, Orthopaedic Medicine Seminars and the
Association of Chartered Physiotherapists in Orthopaedic Medicine;
Fellow of Chartered Society of Physiotherapists, London, UK
Steve Longworth
MB CHB MSC FRCGP DM-SMED DPCR FSOM
Principal in General Practice, East Leicester Medical Practice,
Uppingham Road Health Centre, Leicester, UK
Foreword by
Peter Maddison
MD FRCP
Consultant Rheumatologist, North West Wales and Professor of Joint and Muscle
Disorders, School of Sport, Health and Exercise Science, University of Wales, Bangor, UK
EDINBURGH LONDON NEW YORK OXFORD PHILADELPHIA
ST LOUIS SYDNEY TORONTO 2006
ELSEVIER CHURCHILL
LIVINGSTONE
An imprint of Elsevier Limited
First and second editions Stephanie Saunders 1997, 2002
Third edition 2006, Elsevier Limited. All rights reserved.
The right of Stephanie Saunders and Steve Longworth to be identified as authors of this
work has been asserted by them in accordance with the Copyright, Designs and Patents
Act 1988
No part of this publication may be reproduced, stored in a retrieval system, or
transmitted in any form or by any means, electronic, mechanical, photocopying,
recording or otherwise, without either the prior permission of the Publishers. Permissions
may be sought directly from Elsevier's Health Sciences Rights Department, 1600 John F.
Kennedy Boulevard, Suite 1800, Philadelphia, PA 19103-2899, USA: phone:
([phone], fax: [phone], or, e-mail: [email protected].
You may also complete your request on-line via the Elsevier homepage
(http://www.elsevier.com), by selecting 'Support and contact' and then 'Copyright and
Permission'.
First edition 1997
Second edition 2002
Third edition 2006
ISBN-10 0443 074984
ISBN-13 978 0443 07498 1
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
A catalog record for this book is available from the Library of Congress
Notice
Knowledge and best practice in this field are constantly changing. As new research and
experience broaden our knowledge, changes in practice, treatment and drug therapy may
become necessary or appropriate. Readers are advised to check the most current
information provided (i) on procedures featured or (ii) by the manufacturer of each
product to be administered, to verify the recommended dose or formula, the method and
duration of administration, and contraindications. It is the responsibility of the
practitioner, relying on their own experience and knowledge of the patient, to make
diagnoses, to determine dosages and the best treatment for each individual patient, and
to take all appropriate safety precautions. To the fullest extent of the law, neither the
Publisher nor the Authors assume any liability for any injury and/or damage to persons
or property arising out of or related to any use of the material contained in this book.
The Publisher
your source for books,
journals and multimedia
in the health sciences The
publisher's
www.elsevierhealth.com policy is to use
paper manufactured
from sustainable forests
Printed in China by CTPS
The CD-ROM accompanying this text includes video sequences of all the
techniques indicated in the text by the icon. To look at the video for a given
technique, click on the relevant icon in the contents list on the CD-ROM.
The CD-ROM is designed to be used in conjunction with the text and not
as a stand-alone product.
Foreword viii
Preface ix
The evidence base for injection therapy x
The drugs 3
Corticosteroids 3
Local anaesthetics 5
Other injectable substances 12
Drug names 14
Costs 14
Safety 16
Aseptic technique 16
Immediate adverse reactions 16
Treatment of severe allergic reactions 18
Adverse reaction reporting 18
Prevention of adverse reactions 19
Health and safety 19
Emergency supplies for the treatment room 20
Drugs and sport 20
Medicolegal considerations 22
Aspiration, accuracy and miscellaneous injections 24
Aspiration 24
Accuracy of injection 27
Miscellaneous injections 29
Injection technique guidelines 31
Causes and findings 31
Equipment 31
Anatomy 34
Technique 34
Aftercare 36
Comments 37
Alternative approaches 37
Contraindications to injection therapy 38
Absolute contraindications 38
Relative contraindications 38
Preparation protocol 39
Injection technique flowchart 40
Assessment of the upper limb 43
The shoulder 44
Glenohumeral joint 44
Suprascapular nerve 46
Acromioclavicular joint 48
Sternoclavicular joint 50
Subacromial bursa 52
Supraspinatus tendon 54
Infraspinatus tendon 56
Subscapularis tendon and bursa 58
Long head of biceps 60
The elbow 62
Elbow joint 62
Olecranon bursa 64
Common extensor tendon 66
Common flexor tendon 68
Biceps tendon insertion 70
The wrist and hand 72
Wrist joint 72
Inferior radioulnar joint 74
Thumb and finger joints 76
Thumb tendons 78
Flexor tendon nodule 80
Carpal tunnel 82
Summary of suggested upper limb doses 84
Assessment of the lower limb 87
The hip 88
Hip joint 88
Gluteal bursa 90
Psoas bursa 92
Trochanteric bursa 94
Adductor tendons 96
Hamstrings - origin 98
Lateral cutaneous nerve 100
The knee 102
Knee joint 102
Superior tibiofibular joint 104
Coronary ligaments 106
Medial collateral ligament 108
Infrapatellar bursa 110
Pes anseurine bursa 112
lliotibial band bursa 114
Quadriceps expansion 116
Infrapatellar tendon 118
Baker's cyst 120
The ankle and foot 122
Ankle joint 122
Subtalar joint 124
Deltoid ligament 126
Lateral ligament 128
Achilles tendon 130
Achilles bursa 132
Midtarsal joints 134
Toe joints 136
Peroneal tendons 138
Plantar fascia 140
Summary of suggested lower limb doses 142
Spinal injections 147
Assessment of the spine 149
Spine and jaw 150
Cervical facet joints 150
Lumbar facet joints 152
Lumbar nerver roots 154
Caudal epidural 156
Sacroiliac joint 158
Sacrococcygeal joint 160
Temporomandibular joint 162
Summary of suggested spinal doses 164
Appendix 1 Injection survey 165
Appendix 2 Websites 167
References 169
Index 187
The ability to aspirate joints and perform accurate articular and periarticular
injections is an essential skill in managing people with musculoskeletal dis
orders. This manual is an outstanding reference not only for practitioners who
are embarking on developing these skills but also for those of us who need a
reminder about the less commonly performed injection techniques.
Stephanie Saunders, now collaborating with Dr Steve Longworth, has
improved on her original book with every new edition. This third edition is
the best yet and is an exceptionally informative book covering a very wide
range of specific techniques. It is written in a scholarly way and provides a
good background of clinical evidence. For those who like obscure references
there are plenty here. However, it remains a highly practical manual with lots
of good illustrations and helpful flow charts and summary tables. This edition
also comes with a CD-ROM, which is a very useful visual aid to performing
the techniques.
This book will appeal to the broad range of practitioners who are devel
oping joint and soft tissue injection techniques. It is essential reading for
doctors, physiotherapists, nurses and other health professionals involved in
managing musculoskeletal disorders and sports injuries, whether in the
context of primary or secondary care.
Peter Maddison, January 2006