Intra-articular injection: Difference between revisions

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In [[medicine]], an '''intra-articular injection''' is a [[drug administration route]] into the [[synovial fluid]] of a joint space.<ref>{{MeSH}}</ref> Related is an [[arthrocentesis]], which is removing fluid from the [[synovial fluid]].
In [[medicine]], an '''intra-articular injection''' is a [[drug administration route]] into the [[synovial fluid]] of a joint space.<ref>{{MeSH}}</ref> Related is an [[arthrocentesis]], which is removing fluid from the [[synovial fluid]].
==Indications==
The most common indication is for inflammation, using corticosteroid, possibly with a supplementary local anesthetic.


The most common indication is for inflammation, using corticosteroid, possibly with a supplementary local anesthetic.
==Effectiveness==
Intra-articular opioids have been used for postoperative pain relief.<ref>{{citation
Intra-articular opioids have been used for postoperative pain relief.<ref>{{citation
   | title = (Abstract) Pain relief from intra-articular morphine after knee surgery: a qualitative systematic review
   | title = (Abstract) Pain relief from intra-articular morphine after knee surgery: a qualitative systematic review
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  | volume=30 | issue= 1 | date = January-February 2005 | pages=83-98
  | volume=30 | issue= 1 | date = January-February 2005 | pages=83-98
  | doi=10.1016/j.rapm.2004.08.022
  | doi=10.1016/j.rapm.2004.08.022
  | date = http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WPS-4FCR986-D&_user=10&_origUdi=B6T0K-3PH8F8S-3&_fmt=high&_coverDate=01%2F01%2F2005&_rdoc=1&_orig=article&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=5de45d4e81b0c93429ff46ded866efd4}}</ref>
  | url = http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WPS-4FCR986-D&_user=10&_origUdi=B6T0K-3PH8F8S-3&_fmt=high&_coverDate=01%2F01%2F2005&_rdoc=1&_orig=article&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=5de45d4e81b0c93429ff46ded866efd4}}</ref>


Injections of [[methylene blue]] or [[fluoroscein]] have been used to delineate fractures and other damage. This is a painful procedure requiring parenteral as well as local injection. <ref>{{citation
Injections of [[methylene blue]] or [[fluoroscein]] have been used to delineate fractures and other damage. This is a painful procedure requiring parenteral as well as local injection. <ref>{{citation
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  | journal = eMedicine
  | journal = eMedicine
  | date = 10 April 2009}}</ref>
  | date = 10 April 2009}}</ref>
===Sacroiliac joint===
In small [[randomized-controlled trial]]s published before mandatory trial registration, intrarticular [[corticosteroid]]s reduce pain.<ref name="pmid11892709">{{cite journal| author=Luukkainen RK, Wennerstrand PV, Kautiainen HH, Sanila MT, Asikainen EL| title=Efficacy of periarticular corticosteroid treatment of the sacroiliac joint in non-spondylarthropathic patients with chronic low back pain in the region of the sacroiliac joint. | journal=Clin Exp Rheumatol | year= 2002 | volume= 20 | issue= 1 | pages= 52-4 | pmid=11892709 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11892709  }} </ref><ref name="pmid8761190">{{cite journal| author=Maugars Y, Mathis C, Berthelot JM, Charlier C, Prost A| title=Assessment of the efficacy of sacroiliac corticosteroid injections in spondylarthropathies: a double-blind study. | journal=Br J Rheumatol | year= 1996 | volume= 35 | issue= 8 | pages= 767-70 | pmid=8761190 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8761190  }} </ref>
==Technique==
==Technique==
The technique has been reviewed.<ref name="pmid16687707">{{cite journal| author=Thomsen TW, Shen S, Shaffer RW, Setnik GS| title=Videos in clinical medicine. Arthrocentesis of the knee. | journal=N Engl J Med | year= 2006 | volume= 354 | issue= 19 | pages= e19 | pmid=16687707  
The technique has been reviewed.<ref name="pmid16687707">{{cite journal| author=Thomsen TW, Shen S, Shaffer RW, Setnik GS| title=Videos in clinical medicine. Arthrocentesis of the knee. | journal=N Engl J Med | year= 2006 | volume= 354 | issue= 19 | pages= e19 | pmid=16687707  
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| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20222114 | doi=10.1002/art.27448 }} </ref><ref name="pmid19648304">{{cite journal| author=Sibbitt WL, Peisajovich A, Michael AA, Park KS, Sibbitt RR, Band PA et al.| title=Does sonographic needle guidance affect the clinical outcome of intraarticular injections? | journal=J Rheumatol | year= 2009 | volume= 36 | issue= 9 | pages= 1892-902 | pmid=19648304 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=19648304 | doi=10.3899/jrheum.090013 }}</ref><ref name="pmid19851159">{{cite journal| author=Ucuncu F, Capkin E, Karkucak M, Ozden G, Cakirbay H, Tosun M et al.| title=A comparison of the effectiveness of landmark-guided injections and ultrasonography guided injections for shoulder pain. | journal=Clin J Pain | year= 2009 Nov-Dec | volume= 25 | issue= 9 | pages= 786-9 | pmid=19851159 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=19851159 | doi=10.1097/AJP.0b013e3181acb0e4 }}</ref> or may not<ref name="pmid17464615">{{cite journal| author=Rutten MJ, Maresch BJ, Jager GJ, de Waal Malefijt MC| title=Injection of the subacromial-subdeltoid bursa: blind or ultrasound-guided? | journal=Acta Orthop | year= 2007 | volume= 78 | issue= 2 | pages= 254-7 | pmid=17464615  url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=17464615 | doi=10.1080/17453670710013762 }}</ref><ref name="pmid18621974">{{cite journal| author=Luz KR, Furtado RN, Nunes CC, Rosenfeld A, Fernandes AR, Natour J| title=Ultrasound-guided intra-articular injections in the wrist in patients with rheumatoid arthritis: a double-blind, randomised controlled study. | journal=Ann Rheum Dis | year= 2008 | volume= 67 | issue= 8 | pages= 1198-200 | pmid=18621974  
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20222114 | doi=10.1002/art.27448 }} </ref><ref name="pmid19648304">{{cite journal| author=Sibbitt WL, Peisajovich A, Michael AA, Park KS, Sibbitt RR, Band PA et al.| title=Does sonographic needle guidance affect the clinical outcome of intraarticular injections? | journal=J Rheumatol | year= 2009 | volume= 36 | issue= 9 | pages= 1892-902 | pmid=19648304 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=19648304 | doi=10.3899/jrheum.090013 }}</ref><ref name="pmid19851159">{{cite journal| author=Ucuncu F, Capkin E, Karkucak M, Ozden G, Cakirbay H, Tosun M et al.| title=A comparison of the effectiveness of landmark-guided injections and ultrasonography guided injections for shoulder pain. | journal=Clin J Pain | year= 2009 Nov-Dec | volume= 25 | issue= 9 | pages= 786-9 | pmid=19851159 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=19851159 | doi=10.1097/AJP.0b013e3181acb0e4 }}</ref> or may not<ref name="pmid17464615">{{cite journal| author=Rutten MJ, Maresch BJ, Jager GJ, de Waal Malefijt MC| title=Injection of the subacromial-subdeltoid bursa: blind or ultrasound-guided? | journal=Acta Orthop | year= 2007 | volume= 78 | issue= 2 | pages= 254-7 | pmid=17464615  url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=17464615 | doi=10.1080/17453670710013762 }}</ref><ref name="pmid18621974">{{cite journal| author=Luz KR, Furtado RN, Nunes CC, Rosenfeld A, Fernandes AR, Natour J| title=Ultrasound-guided intra-articular injections in the wrist in patients with rheumatoid arthritis: a double-blind, randomised controlled study. | journal=Ann Rheum Dis | year= 2008 | volume= 67 | issue= 8 | pages= 1198-200 | pmid=18621974  
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=18621974 | doi=10.1136/ard.2007.084616 }}</ref> increase successful injection or aspiration.
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=18621974 | doi=10.1136/ard.2007.084616 }}</ref> increase successful injection or aspiration.
===Sacroiliac joint===
Even with [[ultrasonography]] guidance, less than half of injections enter the [[sacroiliac joint]].<ref name="pmid20019067">{{cite journal| author=Hartung W, Ross CJ, Straub R, Feuerbach S, Schölmerich J, Fleck M et al.| title=Ultrasound-guided sacroiliac joint injection in patients with established sacroiliitis: precise IA injection verified by MRI scanning does not predict clinical outcome. | journal=Rheumatology (Oxford) | year= 2010 | volume= 49 | issue= 8 | pages= 1479-82 | pmid=20019067 | doi=10.1093/rheumatology/kep424 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20019067  }} </ref>


[[X-ray computed tomography]] has also been used. In a study that also used [[magnetic resonance imaging]] to assess the degree of inflammation, CT guidance was used to inject the sacroiliac joint. <ref>{{citation
[[X-ray computed tomography]] has also been used. In a study that also used [[magnetic resonance imaging]] to assess the degree of inflammation, CT guidance was used to inject the sacroiliac joint. <ref>{{citation

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In medicine, an intra-articular injection is a drug administration route into the synovial fluid of a joint space.[1] Related is an arthrocentesis, which is removing fluid from the synovial fluid.

The most common indication is for inflammation, using corticosteroid, possibly with a supplementary local anesthetic.

Effectiveness

Intra-articular opioids have been used for postoperative pain relief.[2], although a review challenged the efficacy of the practice. [3]

Injections of methylene blue or fluoroscein have been used to delineate fractures and other damage. This is a painful procedure requiring parenteral as well as local injection. [4]

Sacroiliac joint

In small randomized-controlled trials published before mandatory trial registration, intrarticular corticosteroids reduce pain.[5][6]

Technique

The technique has been reviewed.[7]

Guided injection

Various imaging modalities have been used to guide the injection.

Guidance with ultrasonography, rather than relying on palpation by an experienced clinician, may[8][9][10] or may not[11][12] increase successful injection or aspiration.

Sacroiliac joint

Even with ultrasonography guidance, less than half of injections enter the sacroiliac joint.[13]

X-ray computed tomography has also been used. In a study that also used magnetic resonance imaging to assess the degree of inflammation, CT guidance was used to inject the sacroiliac joint. [14]

Drugs used

The most common drugs used are corticosteroids for inflammation, often combined with a local anesthetic.

References

  1. ↑ Anonymous (2024), Intra-articular injection (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. ↑ Eija Kalso et al. (June 1997), "(Abstract) Pain relief from intra-articular morphine after knee surgery: a qualitative systematic review", Pain 71 (2): 127-134, DOI:10.1016/S0304-3959(97)03344-7
  3. ↑ Leiv Arne Rosseland (January-February 2005), Regional Anesthesia and Pain Medicine, vol. 30, DOI:10.1016/j.rapm.2004.08.022, at 83-98
  4. ↑ Gil Z Shlamovitz (10 April 2009), "Injection, Intra-Articular Methylene Blue: Treatment & Medication", eMedicine
  5. ↑ Luukkainen RK, Wennerstrand PV, Kautiainen HH, Sanila MT, Asikainen EL (2002). "Efficacy of periarticular corticosteroid treatment of the sacroiliac joint in non-spondylarthropathic patients with chronic low back pain in the region of the sacroiliac joint.". Clin Exp Rheumatol 20 (1): 52-4. PMID 11892709. [e]
  6. ↑ Maugars Y, Mathis C, Berthelot JM, Charlier C, Prost A (1996). "Assessment of the efficacy of sacroiliac corticosteroid injections in spondylarthropathies: a double-blind study.". Br J Rheumatol 35 (8): 767-70. PMID 8761190. [e]
  7. ↑ Thomsen TW, Shen S, Shaffer RW, Setnik GS (2006). "Videos in clinical medicine. Arthrocentesis of the knee.". N Engl J Med 354 (19): e19. DOI:10.1056/NEJMvcm051914. PMID 16687707. Research Blogging.
  8. ↑ Cunnington J, Marshall N, Hide G, Bracewell C, Isaacs J, Platt P et al. (2010). "A randomized, double-blind, controlled study of ultrasound-guided corticosteroid injection into the joint of patients with inflammatory arthritis.". Arthritis Rheum 62 (7): 1862-9. DOI:10.1002/art.27448. PMID 20222114. Research Blogging.
  9. ↑ Sibbitt WL, Peisajovich A, Michael AA, Park KS, Sibbitt RR, Band PA et al. (2009). "Does sonographic needle guidance affect the clinical outcome of intraarticular injections?". J Rheumatol 36 (9): 1892-902. DOI:10.3899/jrheum.090013. PMID 19648304. Research Blogging.
  10. ↑ Ucuncu F, Capkin E, Karkucak M, Ozden G, Cakirbay H, Tosun M et al. (2009 Nov-Dec). "A comparison of the effectiveness of landmark-guided injections and ultrasonography guided injections for shoulder pain.". Clin J Pain 25 (9): 786-9. DOI:10.1097/AJP.0b013e3181acb0e4. PMID 19851159. Research Blogging.
  11. ↑ Rutten MJ, Maresch BJ, Jager GJ, de Waal Malefijt MC (2007). "Injection of the subacromial-subdeltoid bursa: blind or ultrasound-guided?". Acta Orthop 78 (2): 254-7. DOI:10.1080/17453670710013762. PMID 17464615 url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=17464615. Research Blogging.
  12. ↑ Luz KR, Furtado RN, Nunes CC, Rosenfeld A, Fernandes AR, Natour J (2008). "Ultrasound-guided intra-articular injections in the wrist in patients with rheumatoid arthritis: a double-blind, randomised controlled study.". Ann Rheum Dis 67 (8): 1198-200. DOI:10.1136/ard.2007.084616. PMID 18621974. Research Blogging.
  13. ↑ Hartung W, Ross CJ, Straub R, Feuerbach S, Schölmerich J, Fleck M et al. (2010). "Ultrasound-guided sacroiliac joint injection in patients with established sacroiliitis: precise IA injection verified by MRI scanning does not predict clinical outcome.". Rheumatology (Oxford) 49 (8): 1479-82. DOI:10.1093/rheumatology/kep424. PMID 20019067. Research Blogging.
  14. ↑ Bollow M, et al. (1996 Jul-Aug), "(Abstract) CT-guided intraarticular corticosteroid injection into the sacroiliac joints in patients with spondyloarthropathy: indication and follow-up with contrast-enhanced MRI.", J Comput Assist Tomogr 20: 512-21
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