hip knee injection n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Hip/Knee Injection PowerPoint Presentation
Download Presentation
Hip/Knee Injection

Loading in 2 Seconds...

play fullscreen
1 / 25

Hip/Knee Injection - PowerPoint PPT Presentation


  • 189 Views
  • Uploaded on

Hip/Knee Injection. Mr 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 4 th to 6 th decade Women

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Hip/Knee Injection' - derick


Download Now An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
hip knee injection

Hip/Knee Injection

Mr Andrew Armitage

Horder 2013

hip injections
Hip injections
  • Trochanteric Bursitis
  • Meralgiaparaesthetica
  • Intraarticular - Diagnostic
  • Target injections - iliopsoas
incidence
Incidence
  • 1.8 per 1000 per year
  • 4th to 6th decade
  • Women
  • Obesity
  • Low Back pain
  • Osteoarthitis
causes
Causes
  • Very often no clear cause
  • Trauma
  • Microtrauma (overuse)
  • Osteoarthritis
  • Post THR
  • Leg length inequality
presentation
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
Differential Diagnosis
  • Trochanteric bursitis
  • Snapping Iliotibial band
  • Back pain / radiation
  • Hip arthritis
  • MeralgiaParaesthetica
  • Gluteus medius inflammation
investigation
Investigation
  • Rareley required initially
    • Pathognomic-pain over trochanter
    • Ultrasound
    • Hip Xray
    • MRI
t reatment
Treatment
  • Conservative
    • NSAID
    • Analgesia
    • Reduced activity
    • Topical anti-inflammatories
  • Physiotherapy
    • Massage
    • Ultrasound
  • ESWT
    • Shockwave therapy
treatment
Treatment
  • Injection
    • Local anaesthetic – 10ml 0.5% Marcaine
    • Steroid - 80 mg depo-medrone
    • Big needle
    • Relaxed Patient
    • Target point
    • Hit bone
treatment outcomes
Treatment - outcomes
  • Conservative
    • Majority settle
  • Injection
    • 60 – 90 % success
    • Can take 4 wks
    • Can be repeated
  • Surgery
    • Very rarely indicated
meralgia paraesthtica
Meralgiaparaesthtica
  • Lateral cutaneous nerve of thigh
  • Tinnels
  • Neuralgic pain
knee injections
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
Intraarticular injections
  • Steroids
    • 10ml 0.5% marcaine
    • 80mg Depomedrone
  • Viscosupplementation
    • Synvisc 1
    • Durolane
steroids
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
Viscosupplementation
  • Variable outcome
  • Grade 1-2 oa changes
  • Help 50 -60 %
  • Can last up to a year
  • Can be painful
  • £2-300
pes anserine bursitis iliotibial band syndrome
Pes anserine bursitisiliotibial band syndrome
  • Analgesia
  • Rest
  • Physio
  • Targeted injection
pre patella neuroma
Pre-patella neuroma
  • In bursa
  • Very sensitive
  • Can feel tissue lump/band
  • 2ml local and steroid
  • ? Immediate effect
pre patella bursitis
Pre-Patella bursitis
  • Inflammatory
  • Infective
  • NSAID/rest/ ? Abs
  • Generally don’t inject
  • Occaisionally surgery
patella tendonitis
Patella Tendonitis
  • Rest
  • Analgesia
  • Physiotherapy / U/S
  • Shockwave therapy
  • Do Not Inject