supartz injection techniques
DESCRIPTION
TRANSCRIPT
![Page 1: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/1.jpg)
Injection TechniqueInjection Techniqueforfor
Joint Fluid TherapyJoint Fluid Therapy
A Conservative Treatment of A Conservative Treatment of OsteoarthritisOsteoarthritis
![Page 2: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/2.jpg)
AgendaAgenda
Overview of Osteoarthritis (OA) The Continuum of Care for OA The Role of Joint Fluid Therapy Intra-articular Injection Technique
![Page 3: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/3.jpg)
The KneeThe Knee
![Page 4: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/4.jpg)
The Anatomy of the KneeThe Anatomy of the Knee
![Page 5: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/5.jpg)
CartilageCartilage
lamina splendens
superficial layer
deep layer
cortical bone
cancellous bone
2mm
![Page 6: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/6.jpg)
CartilageCartilage
Proteoglycan aggregate
Chondrocyte
Collagen fibril
Hyaluronan
![Page 7: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/7.jpg)
Cartilage MatrixCartilage Matrix
![Page 8: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/8.jpg)
OsteoarthritisOsteoarthritis
![Page 9: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/9.jpg)
Osteoarthritis of the KneeOsteoarthritis of the Knee
Superoxide Anion
ProteinaseCytokine
Synovitis
Cartilage degradation
Mechanical Stress
Age, Genetics, Gender
Increased Surface Fibrillation and Decreased Lubrication
![Page 10: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/10.jpg)
Effects of OsteoarthritisEffects of Osteoarthritis
Decreased molecular weight of HADecreased molecular weight of HA Decreased concentration of HADecreased concentration of HA Less physical protection from shockLess physical protection from shock Less nerve protectionLess nerve protection Increased chemical breakdown of Increased chemical breakdown of
cartilagecartilage
Decreased molecular weight of HADecreased molecular weight of HA Decreased concentration of HADecreased concentration of HA Less physical protection from shockLess physical protection from shock Less nerve protectionLess nerve protection Increased chemical breakdown of Increased chemical breakdown of
cartilagecartilage
![Page 11: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/11.jpg)
OA Cycle of DegradationOA Cycle of Degradation
F a u l t y S y n t h e s i so r D e g r a d a t i o no f H y a l u r o n a n
J o i n tI m m o b i l i t y
S t a g n a t i o n o fTr a n s s y n o vi a l
F l o w
A c c u m u l a t i o n o fC a t a b o l i t e s a n d
D i s r u p t i o n i nC e l l M e t a b o l i s m
L o w e r V i s c o c i t yo f t h e
I n t r a c e l l u l a rM a t r i x
F a u l t y S y n t h e s i so r D e g r a d a t i o no f H y a l u r o n a n
J o i n tI m m o b i l i t y
S t a g n a t i o n o fTr a n s s y n o vi a l
F l o w
A c c u m u l a t i o n o fC a t a b o l i t e s a n d
D i s r u p t i o n i nC e l l M e t a b o l i s m
L o w e r V i s c o c i t yo f t h e
I n t r a c e l l u l a rM a t r i x
![Page 12: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/12.jpg)
Late Stage OALate Stage OA
![Page 13: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/13.jpg)
Treating OATreating OA
![Page 14: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/14.jpg)
Arthritis & Rheumatism Vol. 43, 9 Sept. 2000, 1905-1915
Recommendations Recommendations for the for the
Medical Management of Medical Management of Osteoarthritis Osteoarthritis
of the Hip And Kneeof the Hip And Knee
American College of American College of RheumatologyRheumatology
Subcommittee on Osteoarthritis Subcommittee on Osteoarthritis
![Page 15: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/15.jpg)
GoalsGoals
Control of Pain Improvement of Function Avoidance of toxic effects
![Page 16: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/16.jpg)
Management PathwayManagement Pathway
1. Non-Pharmacologic (NP)
2. Pharmacologic (P), in addition to maintained NP management.
3. Surgical, when pain is severely symptomatic and not responding to NP or P.
![Page 17: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/17.jpg)
Non-PharmacologicNon-Pharmacologic Patient education
– Self management programs– Personalized social support via telephone– Weight loss– Exercise– Occupational Therapy– Joint Protection and Energy conservation
![Page 18: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/18.jpg)
Non-PharmacologicNon-Pharmacologic
Physical Therapy– muscle strengthening exercises– Assistive devices for ambulation– Patellar taping– Wedged insoles– Bracing– Assistive devices for activities of
daily living
![Page 19: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/19.jpg)
PharmacologicPharmacologic
Oral Intra-articular Topical
![Page 20: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/20.jpg)
PharmacologicPharmacologic
Oral– Acetaminophen, up to 4g per day– COX-2*– NSAID plus Gastroprotectant*– Nonacetylated salicylate*
* After careful assessment of upper GI adverse event risk factors:
Age, comorbidity, oral steroids, history of peptic ulcer and /or upper GI bleeding, anticoagulants
![Page 21: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/21.jpg)
PharmacologicPharmacologic
Intra-articular– Steroids
• Opioids, Glucocorticoids
– Hyaluronan
![Page 22: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/22.jpg)
PharmacologicPharmacologic
Topical– Capsaicin– Methylsalicylate
![Page 23: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/23.jpg)
SurgicalSurgical
Lavage– Unproven
Debridement Osteotomy Total Joint Arthroplasty
![Page 24: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/24.jpg)
Treating OA With Treating OA With Joint Fluid TherapyJoint Fluid Therapy
![Page 25: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/25.jpg)
The Effect of Natural HA The Effect of Natural HA in the Jointin the Joint
Natural HA acts as combination matrix between many kinds of cells – Body fluid, skin, other organs
Joint cartilage– Aggregate to proteoglycan - keeps water.
– 1 g of aglycan can keep 50 mL of water = cartilage elasticity.
Joint fluid– Lubricant and viscous fluid.
– Exists in synovium and capsule. Natural HA
– Density : 2.7 (old) to 4 (young) mg/mL density in normal joint fluid.
– Decreased density and viscosity in the inflammatory joint.
![Page 26: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/26.jpg)
Why use hyaluronan?Why use hyaluronan?
Potential long term problems with steroids.
Safe, clean, easy. Pure and natural. Effects are comfortable and
long-lasting. More attractive to patients
than TKR.
![Page 27: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/27.jpg)
Captures analgesicmediator in synovial
fluid (viscosity, structure of randomcoil,anionic charge)
Inhibitscartilage
degeneration
Improvespathologicaljoint fluids
Covers sensory nerve
receptor of jointtissue
Pain relief and improvement of daily activities
Improveslubricatingfunction
Improvessensitivity
topain
mediator
Indirect Action
Pain Relief for HyaluronanPain Relief for HyaluronanDirect Action
![Page 28: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/28.jpg)
Hyaluronan
SynovialMembraneCartilage
Inhibits proteoglycan release Covers pain receptors
Improves cartilage metabolism Suppresses pain
PENETRATION
Action of Hyaluronan on Joint TissueAction of Hyaluronan on Joint Tissue
![Page 29: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/29.jpg)
The Effective Use of The Effective Use of Sodium HyaluronateSodium Hyaluronate Not a cure for OA. Slow-acting and long-lasting. Most effective for
early and middle stage OA.– Very good conservative treatment plan for older
patients with moderate OA! – The relief can be remarkable.
Consider the young athlete.
![Page 30: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/30.jpg)
ConclusionConclusion
OA is an accelerating biochemical cycle causing cartilage degradation.
There is no cure for OA. Sodium hyaluronate is a safe,
effective, non-invasive treatment for mild to moderate stages of OA and patients of all ages.
![Page 31: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/31.jpg)
Injection TechniqueInjection Technique
![Page 32: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/32.jpg)
Injection TechniqueInjection Technique
![Page 33: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/33.jpg)
Injection TechniqueInjection Technique
![Page 34: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/34.jpg)
Injection TechniqueInjection Technique
![Page 35: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/35.jpg)
Injection TechniqueInjection Technique
![Page 36: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/36.jpg)
Injection TechniqueInjection Technique
![Page 37: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/37.jpg)
Injection TechniqueInjection Technique
![Page 38: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/38.jpg)
Injection TechniqueInjection Technique
![Page 39: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/39.jpg)
Injection TechniqueInjection Technique
![Page 40: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/40.jpg)
Injection TechniqueInjection Technique
![Page 41: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/41.jpg)
Injection TechniqueInjection Technique
![Page 42: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/42.jpg)
Injection TechniqueInjection Technique
![Page 43: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/43.jpg)
Injection TechniqueInjection Technique
![Page 44: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/44.jpg)
Injection TechniqueInjection Technique
![Page 45: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/45.jpg)
Injection TechniqueInjection Technique
![Page 46: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/46.jpg)
Injection TechniqueInjection Technique
![Page 47: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/47.jpg)
Injection TechniqueInjection Technique
![Page 48: Supartz injection techniques](https://reader033.vdocuments.mx/reader033/viewer/2022061219/54b8d0f84a7959fb4c8b4578/html5/thumbnails/48.jpg)
Injection TechniqueInjection Technique