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Therapeutic Joint Injections
Brandt C. Wible, MD; A. Keith Rastogi, MD; Julia R. Crim, MD
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KEY FACTS

  • Terminology

    • Preprocedure

      • Outcomes

        TERMINOLOGY

        • Definitions

          • Injection of various medications, most commonly corticosteroid, anesthetic, &/or hyaluronic acid (HA) preparation, for treatment of joint pain

        PREPROCEDURE

        • Indications

          • Contraindications

            • Getting Started

              PROCEDURE

              • Patient Position/Location

                • Procedure Steps

                  • Findings and Reporting

                    • Alternative Procedures/Therapies

                      POST PROCEDURE

                      • Things to Do

                        OUTCOMES

                        • Problems

                          • Complications

                            • Expected Outcomes

                              Selected References

                              1. Kompel AJ et al: Intra-articular corticosteroid injections in the hip and knee: perhaps not as safe as we thought? Radiology. 293(3):656-63, 2019
                              2. Rastogi AK et al: Fundamentals of joint injection. AJR Am J Roentgenol. 1-11, 2016
                              3. Farkas B et al: Increased chondrocyte death after steroid and local anesthetic combination. Clin Orthop Relat Res. 468(11):3112-20, 2010
                              4. Chu CR et al: The in vitro effects of bupivacaine on articular chondrocytes. J Bone Joint Surg Br. 90(6):814-20, 2008
                              5. Piper SL et al: Comparison of ropivacaine and bupivacaine toxicity in human articular chondrocytes. J Bone Joint Surg Am. 90(5):986-91, 2008
                              6. Lambert RG et al: Steroid injection for osteoarthritis of the hip: a randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 56(7):2278-87, 2007
                              7. Robinson P et al: Clinical effectiveness and dose response of image-guided intra-articular corticosteroid injection for hip osteoarthritis. Rheumatology (Oxford). 46(2):285-91, 2007
                              8. Skedros JG et al: Variations in corticosteroid/anesthetic injections for painful shoulder conditions: comparisons among orthopaedic surgeons, rheumatologists, and physical medicine and primary-care physicians. BMC Musculoskelet Disord. 8:63, 2007
                              9. Ozturk C et al: The safety and efficacy of intraarticular hyaluronan with/without corticosteroid in knee osteoarthritis: 1-year, single-blind, randomized study. Rheumatol Int. 26(4):314-9, 2006
                              10. Qvistgaard E et al: Intra-articular treatment of hip osteoarthritis: a randomized trial of hyaluronic acid, corticosteroid, and isotonic saline. Osteoarthritis Cartilage. 14(2):163-70, 2006
                              11. Tehranzadeh J et al: Therapeutic arthrography and bursography. Orthop Clin North Am. 37(3):393-408, vii, 2006
                              12. Tehranzadeh J et al: Cartilage metabolism in osteoarthritis and the influence of viscosupplementation and steroid: a review. Acta Radiol. 46(3):288-96, 2005
                              13. Kullenberg B et al: Intraarticular corticosteroid injection: pain relief in osteoarthritis of the hip? J Rheumatol. 31(11):2265-8, 2004
                              14. Eustace JA et al: Comparison of the accuracy of steroid placement with clinical outcome in patients with shoulder symptoms. Ann Rheum Dis. 56(1):59-63, 1997
                              15. DiStefano V et al: Steroid-induced skin changes following local injection. Clin Orthop Relat Res. 87:254-6, 1972
                              Related Anatomy
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                              Related Differential Diagnoses
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                              References
                              Tables

                              Tables

                              KEY FACTS

                              • Terminology

                                • Preprocedure

                                  • Outcomes

                                    TERMINOLOGY

                                    • Definitions

                                      • Injection of various medications, most commonly corticosteroid, anesthetic, &/or hyaluronic acid (HA) preparation, for treatment of joint pain

                                    PREPROCEDURE

                                    • Indications

                                      • Contraindications

                                        • Getting Started

                                          PROCEDURE

                                          • Patient Position/Location

                                            • Procedure Steps

                                              • Findings and Reporting

                                                • Alternative Procedures/Therapies

                                                  POST PROCEDURE

                                                  • Things to Do

                                                    OUTCOMES

                                                    • Problems

                                                      • Complications

                                                        • Expected Outcomes

                                                          Selected References

                                                          1. Kompel AJ et al: Intra-articular corticosteroid injections in the hip and knee: perhaps not as safe as we thought? Radiology. 293(3):656-63, 2019
                                                          2. Rastogi AK et al: Fundamentals of joint injection. AJR Am J Roentgenol. 1-11, 2016
                                                          3. Farkas B et al: Increased chondrocyte death after steroid and local anesthetic combination. Clin Orthop Relat Res. 468(11):3112-20, 2010
                                                          4. Chu CR et al: The in vitro effects of bupivacaine on articular chondrocytes. J Bone Joint Surg Br. 90(6):814-20, 2008
                                                          5. Piper SL et al: Comparison of ropivacaine and bupivacaine toxicity in human articular chondrocytes. J Bone Joint Surg Am. 90(5):986-91, 2008
                                                          6. Lambert RG et al: Steroid injection for osteoarthritis of the hip: a randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 56(7):2278-87, 2007
                                                          7. Robinson P et al: Clinical effectiveness and dose response of image-guided intra-articular corticosteroid injection for hip osteoarthritis. Rheumatology (Oxford). 46(2):285-91, 2007
                                                          8. Skedros JG et al: Variations in corticosteroid/anesthetic injections for painful shoulder conditions: comparisons among orthopaedic surgeons, rheumatologists, and physical medicine and primary-care physicians. BMC Musculoskelet Disord. 8:63, 2007
                                                          9. Ozturk C et al: The safety and efficacy of intraarticular hyaluronan with/without corticosteroid in knee osteoarthritis: 1-year, single-blind, randomized study. Rheumatol Int. 26(4):314-9, 2006
                                                          10. Qvistgaard E et al: Intra-articular treatment of hip osteoarthritis: a randomized trial of hyaluronic acid, corticosteroid, and isotonic saline. Osteoarthritis Cartilage. 14(2):163-70, 2006
                                                          11. Tehranzadeh J et al: Therapeutic arthrography and bursography. Orthop Clin North Am. 37(3):393-408, vii, 2006
                                                          12. Tehranzadeh J et al: Cartilage metabolism in osteoarthritis and the influence of viscosupplementation and steroid: a review. Acta Radiol. 46(3):288-96, 2005
                                                          13. Kullenberg B et al: Intraarticular corticosteroid injection: pain relief in osteoarthritis of the hip? J Rheumatol. 31(11):2265-8, 2004
                                                          14. Eustace JA et al: Comparison of the accuracy of steroid placement with clinical outcome in patients with shoulder symptoms. Ann Rheum Dis. 56(1):59-63, 1997
                                                          15. DiStefano V et al: Steroid-induced skin changes following local injection. Clin Orthop Relat Res. 87:254-6, 1972