S

Sport and Exercise Medicine ReviewJoint Injections

Part 2Dr. Kevin AsemDr. Wes ClaydenDr. Neil DilworthDr. Mark Leung

Dr. Duong Nguyen (Tutorial April 23, 2020)

Disclosure

S No financial disclosures

Landmarking Part 2

Objectives

S 1) To be able to draw on appropriate landmarks for joints

S 2) To be able to use landmarks to determine appropriate entry point for injection/arthrocentesis procedure

S 3) To use landmarks to help with troubleshooting an injection

CASE

Right knee example: Suprapatellar

Suprapatellar Injection

S https://youtu.be/v1Mc3p8683k

Landmarking

S Have to know your surface anatomy

S Draw surface anatomy on patient

S Improves: ConfidencePre-injection visualization AND Troubleshooting

Knee

S Border of patella

S Patellar tendon

S Anteromedial and anterolateral joint line

Knee

Knee Anterior Landmarks

Shoulder

S Scapular Spine

S Acromion

S Clavicle

S Coracoid

Shoulder

Shoulder

Shoulder

Elbow

S Medial and lateral epicondyle - circle

S Ulnar nerve – Marked with parallel lines

S Olecranon – circle

S Midline posterior ulna - Line

Elbow

Elbow

Elbow

Elbow

Ankle

S Medial and lateral malleoli

S EHL

S ED

S 5th MT

S Navicular

Ankle

Superimposed NV on surface

Surface Anatomy - Antlat

Surface Anatomy -AntMed

EHL

Summary

S Know your surface anatomy

S Landmark prior to every injection

S Use landmarks to help guide your troubleshooting during injection

References:

S http://sportmedschool.com/instructional-videos/

S https://www.rheumtutor.com/injection-techniques/msk-injection-techniques-teaching-demonstration-series/

S Rastogi AK, Davis KW, Ross A, Rosas HG. Fundamentals of Joint Injection.AJR Am J Roentgenol. 2016 Sep;207(3):484-94. doi: 10.2214/AJR.16.16243. Epub 2016 Jun 8. Review.

S Courtney P, Doherty M. Joint aspiration and injection and synovial fluid analysis. Best Pract Res Clin Rheumatol. 2013 Apr;27(2):137-69. doi: 10.1016/j.berh.2013.02.005.

S Heers G1, Götz J, Schubert T, Schachner H, Neumaier U, Grifka J, Hedtmann A. MR imaging of the intraarticular disk of the acromioclavicular joint: a comparison with anatomical, histological and in-vivo findings. Skeletal Radiol. 2007 Jan;36(1):23-8. Epub 2006 Aug 15.

S Fam A; Lawry G Fam's musculoskeletal examination and joint injection techniques Philadelphia : Mosby, c2010. 2nd edition.

S McNabb J A practical guide to joint & soft tissue injection & aspiration Philadelphia : Lippincott Williams & Wilkins, c2005.

S Weiss L. Easy injections Philadelphia : Butterworth-Heinemann/Elsevier, c2007.

S Baima J1, Isaac Z. Clean versus sterile technique for common joint injections: a review from the physiatry perspective. Curr Rev Musculoskelet Med. 2008 Jun;1(2):88-91. doi: 10.1007/s12178-007-9011-2.