Intra-articular injection
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.
Indications
The most common indication is for inflammation, using corticosteroid, possibly with a supplementary local anesthetic.
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]
Technique
The technique has been reviewed.[5]
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[6][7][8] or may not[9][10] increase successful injection or aspiration.
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. [11]
Drugs used
The most common drugs used are corticosteroids for inflammation, often combined with a local anesthetic.
References
- ↑ Anonymous (2024), Intra-articular injection (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ 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
- ↑ Leiv Arne Rosseland (January-February 2005), Regional Anesthesia and Pain Medicine, vol. 30, DOI:10.1016/j.rapm.2004.08.022, at 83-98
- ↑ Gil Z Shlamovitz (10 April 2009), "Injection, Intra-Articular Methylene Blue: Treatment & Medication", eMedicine
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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