Intra-articular injection

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In medicine, an intra-articular injection is a drug administration route into the synovial fluid of a joint space.[1] Related is an arthrocentesis, which is removing fluid from the synovial fluid.

The most common indication is for inflammation, using corticosteroid, possibly with a supplementary local anesthetic.

Effectiveness

Intra-articular opioids have been used for postoperative pain relief.[2], although a review challenged the efficacy of the practice. [3]

Injections of methylene blue or fluoroscein have been used to delineate fractures and other damage. This is a painful procedure requiring parenteral as well as local injection. [4]

Sacroiliac joint

In small randomized-controlled trials published before mandatory trial registration, intrarticular corticosteroids reduce pain.[5][6]

Technique

The technique has been reviewed.[7]

Guided injection

Various imaging modalities have been used to guide the injection.

Guidance with ultrasonography, rather than relying on palpation by an experienced clinician, may[8][9][10] or may not[11][12] increase successful injection or aspiration.

Sacroiliac joint

Even with ultrasonography guidance, less than half of injections enter the sacroiliac joint.[13]

X-ray computed tomography has also been used. In a study that also used magnetic resonance imaging to assess the degree of inflammation, CT guidance was used to inject the sacroiliac joint. [14]

Drugs used

The most common drugs used are corticosteroids for inflammation, often combined with a local anesthetic.

References

  1. Anonymous (2015), Intra-articular injection (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. Eija Kalso et al. (June 1997), "(Abstract) Pain relief from intra-articular morphine after knee surgery: a qualitative systematic review", Pain 71 (2): 127-134, DOI:10.1016/S0304-3959(97)03344-7
  3. Leiv Arne Rosseland (January-February 2005), Regional Anesthesia and Pain Medicine, vol. 30, DOI:10.1016/j.rapm.2004.08.022, at 83-98
  4. Gil Z Shlamovitz (10 April 2009), "Injection, Intra-Articular Methylene Blue: Treatment & Medication", eMedicine
  5. Luukkainen RK, Wennerstrand PV, Kautiainen HH, Sanila MT, Asikainen EL (2002). "Efficacy of periarticular corticosteroid treatment of the sacroiliac joint in non-spondylarthropathic patients with chronic low back pain in the region of the sacroiliac joint.". Clin Exp Rheumatol 20 (1): 52-4. PMID 11892709[e]
  6. Maugars Y, Mathis C, Berthelot JM, Charlier C, Prost A (1996). "Assessment of the efficacy of sacroiliac corticosteroid injections in spondylarthropathies: a double-blind study.". Br J Rheumatol 35 (8): 767-70. PMID 8761190[e]
  7. Thomsen TW, Shen S, Shaffer RW, Setnik GS (2006). "Videos in clinical medicine. Arthrocentesis of the knee.". N Engl J Med 354 (19): e19. DOI:10.1056/NEJMvcm051914. PMID 16687707. Research Blogging.
  8. Cunnington J, Marshall N, Hide G, Bracewell C, Isaacs J, Platt P et al. (2010). "A randomized, double-blind, controlled study of ultrasound-guided corticosteroid injection into the joint of patients with inflammatory arthritis.". Arthritis Rheum 62 (7): 1862-9. DOI:10.1002/art.27448. PMID 20222114. Research Blogging.
  9. Sibbitt WL, Peisajovich A, Michael AA, Park KS, Sibbitt RR, Band PA et al. (2009). "Does sonographic needle guidance affect the clinical outcome of intraarticular injections?". J Rheumatol 36 (9): 1892-902. DOI:10.3899/jrheum.090013. PMID 19648304. Research Blogging.
  10. Ucuncu F, Capkin E, Karkucak M, Ozden G, Cakirbay H, Tosun M et al. (2009 Nov-Dec). "A comparison of the effectiveness of landmark-guided injections and ultrasonography guided injections for shoulder pain.". Clin J Pain 25 (9): 786-9. DOI:10.1097/AJP.0b013e3181acb0e4. PMID 19851159. Research Blogging.
  11. Rutten MJ, Maresch BJ, Jager GJ, de Waal Malefijt MC (2007). "Injection of the subacromial-subdeltoid bursa: blind or ultrasound-guided?". Acta Orthop 78 (2): 254-7. DOI:10.1080/17453670710013762. PMID 17464615 url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=17464615. Research Blogging.
  12. Luz KR, Furtado RN, Nunes CC, Rosenfeld A, Fernandes AR, Natour J (2008). "Ultrasound-guided intra-articular injections in the wrist in patients with rheumatoid arthritis: a double-blind, randomised controlled study.". Ann Rheum Dis 67 (8): 1198-200. DOI:10.1136/ard.2007.084616. PMID 18621974. Research Blogging.
  13. Hartung W, Ross CJ, Straub R, Feuerbach S, Schölmerich J, Fleck M et al. (2010). "Ultrasound-guided sacroiliac joint injection in patients with established sacroiliitis: precise IA injection verified by MRI scanning does not predict clinical outcome.". Rheumatology (Oxford) 49 (8): 1479-82. DOI:10.1093/rheumatology/kep424. PMID 20019067. Research Blogging.
  14. Bollow M, et al. (1996 Jul-Aug), "(Abstract) CT-guided intraarticular corticosteroid injection into the sacroiliac joints in patients with spondyloarthropathy: indication and follow-up with contrast-enhanced MRI.", J Comput Assist Tomogr 20: 512-21