Injection Techniques in Musculoskeletal Medicine: A Practical Manual for Clinicians in Primary and Secondary Care PDF
Preview Injection Techniques in Musculoskeletal Medicine: A Practical Manual for Clinicians in Primary and Secondary Care
https://t.me/MBS_MedicalBooksStore www.injectiontechniquesonline.com Log on and follow the instructions to upgrade and gain unlimited access to: Musculoskeletal Injection Techniques Trainer A virtual aid to test your anatomical knowledge and technical skill in injection therapy. • Covers the top most common injection techniques by body region - upper and lower limbs and the spine • Watch >50 video clips • Access animations & self-testing Perfect for honing your skills! https://t.me/MBS_MedicalBooksStore INJECTION TECHNIQUES IN MUSCULOSKELETAL MEDICINE A PRACTICAL MANUAL FOR CLINICIANS IN PRIMARY AND SECONDARY CARE Log on to: www.injectiontechniquesonline.com • your virtual trainer on the top most common injection techniques by body region • >50 video clips • animations & self-testing INJECTION TECHNIQUES IN MUSCULOSKELETAL MEDICINE A PRACTICAL MANUAL FOR CLINICIANS IN PRIMARY AND SECONDARY CARE FIFTH EDITION Stephanie Saunders, FCSP, FSOM Founder and Director, Orthopaedic Medicine Seminars, London, England Steve Longworth, MB, ChB, MSc (Sport and Ex Med), FRCGP, FRACGP, DM-SMed DPCR, FSOM General Practitioner, CY O’Connor Village Medical Centre, Piara Waters, Perth, Western Australia , Foreword by Jonathan Botting FRCGP EDINBURGH LONDON NEW YORK OXFORD PHILADELPHIA ST LOUIS SYDNEY TORONTO 2019 © 2019 Elsevier Ltd. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations, such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). First edition 1997 Second edition 2002 Third edition 2006 Reprinted 2007, 2008, 2009 Fourth edition 2012 Fifth edition 2019 ISBN 978-0-7020-6957-4 Notices Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds or experiments described herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or contributors for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. The publisher’s policy is to use paper manufactured from sustainable forests Printed in China Last digit is the print number: 9 8 7 6 5 4 3 2 1 For Elsevier Content Strategists: Poppy Garraway Smith and Serena Castelnovo Content Development Specialist: Katie Golsby Project Manager: Joanna Souch Designer: Miles Hitchen Illustration Manager: Nichole Beard Illustrator: Graphic World THE DRUGS vviiii Dedication To Alan – with my thanks for his quiet patience during the writing of this edition (despite having no idea what it was about), and to my family for their amused tolerance. SS To Stephanie, who taught me such a lot, and to my patients, who taught me even more. SL https://t.me/MBS_MedicalBooksStore vviiiiii CONTENTS Acknowledgements Thanks to the supportive team at Elsevier and to Ryan Probyn for baring his body for the photos. THE DRUGS iixx Foreword Stephanie Saunders helped me transform the care i give my patients; her teaching continues to influence my everyday practice as a GP. We met on her Orthopaedic Medicine course; i was a GP outnumbered by physiotherapists. Outnumbered and out of my depth. Through her expert teaching i have progressed from pupil to practitioner to teacher. What she and Steve Longworth (a GP and musculo-skeletal expert) bring to this book is their clarity and depth of thought combined with a forensically detailed approach to diagnosis and treatment. This is delivered in very easy to follow steps, laid out with great clarity which makes the book both an effortless and intuitive source of reference. Stephanie’s Orthopaedic Medicine course exposed my own inadequate level of musculoskeletal knowledge gained in training as a doctor. My experience as a GP and GP trainer has uncovered similar gaps in knowledge in many of the doctors i meet. This book should be considered a core reference in every GP practice, and every physiotherapy, rheumatology and orthopaedic department. it should also be considered an essential read for every trainee in those specialties. The opening chapters succinctly and clearly provide detailed references for evidence based joint injection practice. Next the reader is introduced to a logical, chapter structure based on anatomical location, each encompassing how to diagnose specific conditions and how to treat them. For physiotherapists extending their practice to incorporate injection therapy this book is invaluable. For rheumatology and orthopaedic departments this book provides an excellent guide to assessing and injecting patients without the need for imaging. For GPs and for doctors in training the book does all of the above, and in addition it introduces them to a range of conditions not covered in most generic medical training. Almost 30 years in GP practice has taught me how often colleagues and trainees fit their patients and their symptoms to conditions that they are familiar with. This book will not only give clinicians the skill to diagnose and treat more with confidence but also to know when not to treat. in writing this foreword i have come to realise that in our on-line world where every fact is available at the touch of a button i have but three reference books that never gather dust in my clinic. One is a photographic atlas of anatomy (now sadly out of print), the second is the British National Formulary (on-line but better in print) and the third is my copy of Injection Techniques in Musculoskeletal Medicine. it is the last of these that deserves the title of vade mecum. Jonathan Botting, FRCGP London 2018 xx CONTENTS Preface I have always found the process of diagnosis fascinating. It is somewhat like doing a complicated crossword puzzle, where one is given faint clues and hints. These may or may not assist in helping one to process waves of superfluous information in order to arrive, hopefully, at a final answer – the all-important diagnosis. For me, this is always the most challenging and rewarding part of clinical practice. Choice of treatment tends to be dictated by the diagnosis and the clinician’s skills, so is slightly less challenging but, for successful injections, correct diagnosis is the key, together with an intimate knowledge of anatomy. The actual process of giving the injection is simple. For this reason, we have added a section on diagnosis in this edition, which is based on many years of experience in treating musculoskeletal conditions. This experience not only taught us much about human behaviour, but also enabled us to teach a method of diagnostic reasoning to clinicians attending our injection therapy courses. We hope it will also aid you. For new readers, the purpose of this text is to provide a clear practical manual on the basic principles of injection therapy, which can be easily used in primary care and outpatient settings. It is not intended to be an academic text with detailed discussion of alternatives to injection therapy, of which there are many, so further reading is recommended. In this edition, we have added more diagnostic guides, simplified some of the instructions, re-shot the examination process, included boxed Practical Points and updated references, which were current when we went to print in 2018. This is the fifth edition of our textbook, and we are grateful for the success of previous editions. My final thank you is, as before, to the many wonderful patients I was fortunate enough to encounter, to the questioning students who kept me on my toes and, of course, to my co-author Steve Longworth, whose enthusiasm for the subject has never waned – despite his emigration to Australia! Stephanie Saunders, FCSP, FSOM Richmond, England 2018 THE DRUGS xxii About the Authors Stephanie Saunders, FCSP, FSOM, trained at St Thomas’ Hospital, London, and joined the Orthopaedic Medicine team there, headed by Dr James Cyriax. He became her mentor and, in 1977, invited her to lead a teaching group on a lecture tour in Atlanta, Georgia. This led to many years of teaching courses in orthopaedic medicine in the United Kingdom, United States, Canada, Australia, South Africa and several European countries, in between running a busy private practice in London. She was the founding Vice-Chairman of the Society of Orthopaedic Medicine (SOM) and, as Director of Teacher Training, instructed many clinicians in how to teach these courses. She was also founding chair and journal editor for the Association of Chartered Physiotherapists in Orthopaedic Medicine. in 1995, she designed and led the first injection therapy course for chartered physiotherapists in the United Kingdom and has continued to promote this skill in connection with the Chartered Society of Physiotherapy (CSP) and the Department of Health. Fellowship of the CSP was awarded for her work in achieving injection rights for allied health professionals in the UK. As well as being the keynote speaker at several international meetings worldwide, she has published many papers and clinical guidelines. Her textbook, originally entitled Injection Techniques in Orthopaedic Medicine, now entitled Injection Techniques in Musculoskeletal Medicine, was first published in 1997 and is now in its fifth edition. On her recent retirement, she is even busier with family, friends and travelling with her new husband. Dr. Stephen Longworth, MSc (Sport and Exercise Medicine), FRCGP, FRACGP, DM-SMed, DPCR, FSOM – graduated from the University of Manchester in the United Kingdom in 1981 and was a full-time general practitioner (GP) in Leicester for 30 years before moving to Western Australia, where he has worked as a GP since 2015. For 15 years, he also worked as a Specialist Doctor in the Orthopaedic Spine Clinic at Leicester General Hospital for one session per week, having previously worked there in the Shoulder Clinic. He was the first General Practitioner with Special interest in Musculoskeletal Medicine in Leicester and, for several years, was a musculoskeletal mentor to a number of other GP practices in Leicester. He has a Master’s degree in Sport and Exercise Medicine and diplomas in Musculoskeletal Medicine and Primary Care Rheumatology. He is a past president of the Primary Care Rheumatology Society and was a tutor and examiner for the Diploma in Primary Care Rheumatology at the University of Bath. He was a GP Trainer, appraiser and undergraduate tutor and has served on more committees and boards than he cares to remember. He was a Visiting Professor in the Department of Clinical Skills at St. George’s University Medical School, Grenada, West indies, in the Caribbean.
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