Indications

i)

Bursitis

ii)

Tenosynovitis / Tendinopathy

iii)

Osteoarthritis

iv)

Epicondylitis

v)

Capsulitis

vi)

Morton's Neuroma

vii)

Ganglion

Technique

TRIAMCINOLONE in conjunction with XYLOCAINE OR MARCAIN is most commonly used.

ACCURATE needle tip position at the site of pathology is ensured with either ultrasound, fluoroscopic or CT guidance.

The interventions are all performed under sterile conditions.

The ultrasound technique is the same as that used for breast lesion biopsy with the needle path imaged in real-time from the skin surface to site of concern.

Clinical Examples

Many doctors are happy to perform palpation guided local anaesthetic or steroid injections particularly for conditions such as subacromial bursitis or lateral epicondylitis. Imaging guidance is not necessarily required if the clinician feels confident with where they are placing the needle. It is important not to inject into the substance of a tendon under pressure as there is now a body of evidence that tendon damage and possible future tendon rupture can occur as a complication.

a)

Hip joint osteoarthritis awaiting hip replacement
Intra-articular corticosteroid injection under fluoroscopic guidance usually provides several months of pain relief.

b)

Tenosynovitis (any tendon sheath)
Ultrasound guidance will ensure the medication is injected into the tendon sheath of concern and not into the tendon itself.

c)

Dorsal wrist pain with scapholunate ganglion
Approximately 70% of ganglion cysts in the wrist / hand region arise form the margin of the scapholunate joint. They are often not palpable and diagnosed by ultrasound. Ultrasound guided aspiration and injection is often helpful and can make surgery unnecessary.

d)

Frozen shoulder (Adhesive Capsulitis)
If a combination of clinical examination and imaging has diagnosed adhesive capsulitis and eliminated subacromial bursitis and rotator cuff tear as the cause of shoulder pain then fluoroscopic guided steroid injection into the glenohumeral joint is usually very successful. If the clinician desires the joint capsule can be distended and stretched with normal saline at the same time.

e)

Back Pain with no Neurological Signs Secondary to Facet Joint Arthritis
Fluoroscopic guided facet joint injections in the lumbar spine are very commonly requested in Australia. If the back pain does not respond to conservative measures this procedure can be very helpful.