Joint and Soft Tissue Injections

Chapter 168 Joint and Soft Tissue Injections




Clinical Case Problem 1: A Landscaper with a Sore Shoulder


A 34-year-old man presents to your office requesting soft tissue injection of painful trigger points in his right shoulder. He read about this therapy on the Internet. He works as a laborer at a local landscaping business and has tried a variety of treatments, including acupuncture and chiropractic manipulation, for chronic intermittent pain in his right shoulder. There is no history of trauma or arthritides. On examination, he is a muscular white man with several tender points along the anterior border of his right trapezius muscle. The rest of his examination is normal.



Select the best answer to the following questions




1. All except which of the following are reasonable and acceptable reasons for use of diagnostic and therapeutic injections?


a. to aspirate fluid from a joint for diagnosis

b. to deliver an antibiotic into an infected joint space

c. to relieve pain and inflammation at a trigger point

d. to confirm a presumptive diagnosis through pain relief

e. to deliver an antiinflammatory medication to an affected joint space

2. Which of the following aspects of history, if present, is not an absolute contraindication to therapeutic injection of a corticosteroid?


a. allergy to local anesthetic

b. type 2 diabetes mellitus

c. evidence of an infected joint space

d. high possibility of a fracture involving the targeted joint

e. local cellulitis

3. Possible complications of therapeutic corticosteroid injection include all except which of the following?


a. local infection caused by the injection

b. steroid flare after injection of corticosteroids

c. local swelling and redness

d. local depigmentation

e. induction of coagulopathy

4. Postinjection instructions should pay particular attention to which of the following?


a. proper dressing of the site

b. signs of complications

c. mobility restrictions, if any

d. use of medications

e. all of the above


Clinical Case Problem 2: A Woman with a Hot Knee


A 58-year-old woman presents to your office with acute onset of a painful, swollen, hot knee. This is the first episode of this illness in this patient, which began 24 hours ago. There is no history of trauma, hyperuricemia, fever, chills, or other recent infections. Her only medication is hydrochlorothiazide for hypertension. On examination, vital signs are normal, and the left knee is as described with an obvious effusion. The rest of the examination is normal.



5. Reasonable management at this time includes which of the following?


a. discontinuation of the hydrochlorothiazide

b. aspiration of the affected joint

c. institution of physical therapy

d. beginning a nonsteroidal antiinflammatory

e. all of the above

6. Laboratory analysis of joint fluid is obtained and reveals gram-negative cocci seen in pairs. What is the most appropriate therapy at this time?


a. intraarticular fluoroquinolone

b. oral dicloxacillin

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Joint and Soft Tissue Injections

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