Silver's joint and soft tissue injection: injecting with confidence

169 Pages·2019·16.584 MB·English

by  Silver, David, Silver, Trevor

S I X T H E D I T I O N
SILVER’S JOINT
AND SOFT TISSUE
INJECTION
INJECTING WITH CONFIDENCE
Trevor Silver (1927–2011)
Dr Silver was a general practitioner (GP) with an interest in the management
of musculoskeletal conditions, notably injection therapy. Throughout his career,
he was interested in education and training. For many years, he was Regional
Adviser to South West Thames Region British Postgraduate Medical Federation
and held a number of important roles within the Royal College of General
Practitioners, including Chair and Provost of the South West Thames Faculty.
He chaired many management, education and research committees, including
the local division of the BMA and his regional health authority regional
research committee.
He was a GP advisor to the Arthritis and Rheumatism Council and a trainer to
the Royal Army Medical Corps (RAMC). He contributed to original research on
the regional inequalities of GP training in inner city areas. He travelled widely
to deliver his highly regarded soft tissue and joint injection workshops and
published the successful book, Joint and Soft Tissue Injection. (Adapted from
BMJ 2011; 343:d7233 with permission from BMJ Publishing Group Ltd.)
S I X T H E D I T I O N
SILVER’S JOINT
AND SOFT TISSUE
INJECTION
INJECTING WITH CONFIDENCE
E D I T E D B Y
DAVID SILVER
FRCR FRCP
Consultant Musculoskeletal Radiologist
Royal Devon and Exeter NHS Foundation Trust
Past President, British Society of Skeletal Radiologists
UK
CRC Press
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Contents
Preface to the first edition xi
Preface to the second edition xiii
Preface to the third edition xv
Preface to the fourth edition xvii
Preface to the fifth edition xix
Preface to the sixth edition xxi
Introduction xxiii
About the author xxv
Contributors xxvii
Abbreviations xxix
1 Incidence and general principles 1
Frequency of injection 4
Anticoagulation 4
Choice of steroid 4
Contraindications to the use of steroids 5
Local anaesthetic 6
Post-injection advice 6
References 6
Further reading 7
2 Joint and soft tissue corticosteroid injection:
what is the evidence? 9
Introduction 10
Upper limb 10
Shoulder 10
Elbow 11
Hand 11
Lower limb 12
Hip 12
Hip/knee 12
Foot 12
What should we inject? 13
How often do we inject? 13
Is it safe to inject in the diabetic patient? 13
What is the role of image-guided injection? 13
References 15
3 Medico-legal issues, complications and consent 17
Introduction 18
Technique of the procedure 18
Untoward complications of steroid injection 18
Lipodystrophy 18
vi Contents
Loss of skin pigment 18
Hyperglycaemia 19
Infection 19
Pain after injection 19
Potential complications from injection 20
Informed consent 20
‘Prudent doctor/prudent patient’ 20
Implied consent 20
Express consent 21
Injection procedures 21
Written consent 21
Documentation of consent 21
References 22
Further reading 22
4 The challenge of recognising and managing
inflammatory arthritis 23
Introduction 24
Background: the burden of inflammatory disease 24
Challenges to diagnosis 24
How to diagnose 25
Clinical findings 25
Special investigations 25
Management 25
Injecting in inflammatory arthritis 26
Conclusion 27
References 27
5 The shoulder 29
Introduction 30
Presentation and diagnosis 30
Pitfalls in diagnosis 32
Referred pain to the tip of the shoulder 32
Pain referred to the deltoid insertion 33
Functional anatomy 33
The acromioclavicular joint 33
Examination of the shoulder 34
What the pain means 36
Pain on resisted abduction 36
Resisted external rotation 36
Resisted internal rotation 36
Resisted supination and flexion of the forearm 36
Injection technique 38
Anterior approach 38
Lateral (subacromial) approach 40
Posterior approach 42
Bicipital tendinosis 44
Injection technique 44
Contents vii
Acromioclavicular joint arthritis 46
Injection technique 46
Physiotherapy: the shoulder 48
Summary 48
Shoulder impingement 48
‘Frozen’ shoulder/shoulder capsulitis 48
Acromioclavicular joint arthritis 48
References 49
6 The wrist and hand 51
Incidence 52
Common problems treated with steroid injections 52
The first carpometacarpal joint 53
Presentation and diagnosis 53
Functional anatomy 53
Injection technique 54
Metacarpal and interphalangeal joints 56
Functional anatomy 56
Injection technique 56
Carpal tunnel syndrome 56
Presentation and diagnosis 56
Tinel’s test 57
Phelan’s test 57
Functional anatomy 57
Injection technique 58
De Quervain’s tenosynovitis 60
Presentation and diagnosis 60
Functional anatomy 60
Injection technique 60
Post-injection advice 60
Trigger finger 62
Presentation and diagnosis 62
Functional anatomy 62
Injection technique 62
Physiotherapy: wrist and hand 64
First carpometacarpal, metacarpal and interphalangeal
joint osteoarthritis 64
Carpal tunnel syndrome 64
De Quervain’s tenosynovitis 64
Trigger finger 64
References 65
7 The elbow 67
Introduction 68
Tennis elbow 68
Presentation and diagnosis 68
Functional anatomy 68
Injection technique 68
viii Contents
Golfer’s elbow 71
Presentation and diagnosis 71
Functional anatomy 71
Injection technique 72
Post-injection advice 72
Lipodystrophy 72
Physiotherapy: tennis and golfer’s elbow 72
Olecranon bursitis 74
Elbow joint 76
Presentation 76
Functional anatomy 76
Injection technique 76
Physiotherapy: elbow joint 76
8 Conditions around the hip and thigh 79
The hip 80
Trochanteric bursitis 80
Injection technique 80
Ischiogluteal bursitis (hamstring tendinopathy) 82
Injection technique 82
Meralgia paraesthetica 84
Injection technique 84
Iliotibial band friction syndrome 86
Presentation and diagnosis 86
Functional anatomy 86
Injection technique 86
Physiotherapy: conditions around the hip and thigh 88
Trochanteric bursitis 88
Ischiogluteal bursitis 88
Meralgia paraesthetica 88
Iliotibial band friction syndrome 89
Reference 89
9 The knee joint 91
Introduction 92
Presentation and diagnosis 92
Functional anatomy 92
Aspiration and injection therapy 93
Technique of aspiration and injection 94
Aspiration 94
Injection 94
Physiotherapy: the knee 96
References 96
Further reading 96
10 The ankle and foot 97
Introduction 98
Functional anatomy 98
Contents ix
Presentation of some common problems 98
Injection technique 100
Ankle sprains 100
Achilles tendon 100
Plantar fasciitis: the painful heel 102
Injection technique 102
Tarsal tunnel syndrome 102
The ankle joint 104
Injection technique 104
Tibialis posterior tendinosis 104
Functional anatomy 104
Injection technique 104
Physiotherapy: the ankle and foot 106
Ankle sprains 106
Plantar fasciitis 106
Tarsal tunnel 106
Ankle arthritis 107
Tibialis posterior tendinosis 107
References 107
11 Musculoskeletal imaging and therapeutic options
in soft tissue disorders 109
Introduction 110
Pathophysiology 110
When to image 112
Imaging modalities 112
Radiography 112
Magnetic resonance imaging 114
Ultrasound 114
Relative merits for different imaging modalities 114
Imaging of joints 116
General principles 116
The shoulder 116
Achilles tendon 120
The ankle 122
Plantar fascia 124
The knee 124
Ultrasound in inflammatory disease 126
Ultrasound-guided injection 126
Calcific tendinosis 126
Shockwave therapy 128
Educational aspects of reporting 128
Resource implications 128
Summary 129
Further reading 129
Index 131