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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.