Post on 24-Feb-2016
description
Hip/Knee InjectionMr Andrew Armitage
Horder 2013
Hip injections• Trochanteric Bursitis• Meralgia paraesthetica• Intraarticular - Diagnostic• Target injections - iliopsoas
Trochanteric Bursitis
Trochanteric Bursa
Incidence• 1.8 per 1000 per year• 4th to 6th decade• Women• Obesity• Low Back pain• Osteoarthitis
Causes• Very often no clear cause• Trauma• Microtrauma (overuse)• Osteoarthritis• Post THR• Leg length inequality
Presentation• Patient usually complains of hip pain• Pain over lateral side of hip (over trochanter)• Pain when lying on side• Worse with flexn/extn, increased activity• Not usually in groin• Can radiate down lateral thigh• Post surgery
Differential Diagnosis• Trochanteric bursitis• Snapping Iliotibial band• Back pain / radiation• Hip arthritis• Meralgia Paraesthetica• Gluteus medius inflammation
Investigation• Rareley required initially– Pathognomic-pain over trochanter
– Ultrasound– Hip Xray–MRI
Treatment• Conservative
– NSAID – Analgesia– Reduced activity– Topical anti-inflammatories
• Physiotherapy– Massage– Ultrasound
• ESWT– Shockwave therapy
Treatment• Injection– Local anaesthetic – 10ml 0.5% Marcaine– Steroid - 80 mg depo-medrone– Big needle– Relaxed Patient– Target point– Hit bone
Treatment - outcomes • Conservative
– Majority settle
• Injection– 60 – 90 % success– Can take 4 wks– Can be repeated
• Surgery– Very rarely indicated
Meralgia paraesthtica
• Lateral cutaneous nerve of thigh
• Tinnels • Neuralgic pain
Knee injections• Intraarticular
– Osteoarthritis– Inflammatory disease– Chondromalacia patellae – be carefull
• Extraarticular– Pre-patella neuroma– Pes anserine bursitis– Iliotibial band syndrome– Patella tendonitis– Prepatella bursitis
Intraarticular injections• Steroids – 10ml 0.5% marcaine– 80mg Depomedrone
• Viscosupplementation– Synvisc 1– Durolane
Steroids• Help 50 % with arthritic change• Can take 4-6 wks to have effect• 5-10 % worse short period of time• Tiny risk of infection• Very variable benefit duration• Not if imminent TKR - ^ risk of infection• More benefit with effusion• Very unfit
Viscosupplementation• Variable outcome• Grade 1-2 oa changes• Help 50 -60 %• Can last up to a year• Can be painful• £2-300
Under Patella
Under patella
Arthroscopy portal
Pes anserine bursitisiliotibial band syndrome
• Analgesia• Rest• Physio• Targeted injection
Pre-patella neuroma
• In bursa• Very sensitive • Can feel tissue lump/band• 2ml local and steroid• ? Immediate effect
Pre-Patella bursitis
• Inflammatory• Infective• NSAID/rest/ ? Abs• Generally don’t inject• Occaisionally surgery
Patella Tendonitis
• Rest• Analgesia• Physiotherapy / U/S• Shockwave therapy• Do Not Inject
Questions ?