 Sept. 30 - Oct. 3, 2003 |
| ASSEMBLY EDITION • NEW ORLEANS |
For treatment of conditions ranging from bursitis to fasciitis, joint injections are useful, office-based procedures that are a valuable addition to the treatment armamentarium in any family practice, said James McNabb, M.D., of Mooresville, N.C.
McNabb, a family physician in private practice, and Roy Watkins, M.D., associate clinical professor of family medicine at the University of North Carolina, Chapel Hill, are teaching the finer points of joint injection therapy in the clinical procedure workshop on that topic. The workshop, which requires an additional fee, repeats today at 8 a.m. and 1:30 p.m., Saturday at 8 a.m., and Sunday at 8 a.m; check at registration for ticket availability.
McNabb, who said he does one or two joint injections a day, maintained that injections, or aspiration of synovial fluid from joints, can "tell you many things. You can collect synovial fluid for analysis to check for infection, gout or pseudogout."
For injection, McNabb said that steroids are "pretty much the same, so the goal is (to) get familiar with one so that you are comfortable using it." He uses triamcinolone acetonide (Kenalog) because, he said, "it is the cheapest." He said he dilutes the corticosteroid with local anesthetic (1% lidocaine plain) "so that you get immediate pain relief."
In fact, he said, removing the pain could provide important clues to diagnosis. Frequently, patients will present with a painful shoulder and the inability to raise the arm. "If you inject the joint, and the patient still cannot adduct the arm, that indicates a rotator cuff injury, and you know that the patient should be referred," he explained.
But Watkins said injections should be avoided in patients with extensive cellulitis that can obscure anatomic landmarks. McNabb agreed, noting that the key to successful injection treatment is to "think deeper than the skin -- picture where the needle tip will be."
Another tip: Get organized before doing injections. McNabb recommended setting up an equipment tray in each examination room. He said the tray should contain at least three needles in sizes ranging from 18 ga 1.5 inch (for aspirations) to 25 ga for injections, syringes (5 and 20 cc are recommended), alcohol, betadine, gauze pads, bandages, gloves, ethyl chloride spray, lidocaine and "steroid of choice."
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