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Knee Joint Injection

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Other Names

  • Knee Injection

Background

Anatomy

  • Knee Joint
    • Formed by the articulation of the distal femur, proximal tibia
    • Multiple significant static and dynamic stabilizers
    • Suprapatellar recess communicates directly with the joint

Indications


Contraindications

  • Absolute
    • Anaphylaxis to injectates
    • Overlying cellulitis, skin lesion or systemic infection
  • Relative
    • Can be treated with less invasive means
    • Tendon tear or rupture
    • Hyperglycemia or poorly controlled diabetes
    • Lack of symptom improvement with previous injection

Procedure

Equipment

  • Sterile including chloraprep, chlorhexadine, iodine
  • Ultrasound with sterile probe cover
  • Gloves
  • Needle: typically 21-23 gauge, 1-1.5 inch
  • Syringe: 5-10 mL
  • Gauze
  • Ethyl Chloride
  • Bandage
  • Injectate
    • Local anesthetic, Corticosteroid etc

Preparation

  • Place ultrasound on opposite side of patient
  • Identify sonographic landmarks

Palpation Guided Technique

  • Position: the patient is seated, legs hanging off the examination table
  • Landmarks
    • The lateral compartment approach is the simplest and easiest
    • Identify the lateral tibial plateau, femoral condyle and lateral border of the patella tendon
    • Mark the skin just laterally to the tendon between the femur and tibia
    • Note: the same landmarks can be used to enter from the medial joint space
  • Sterilize the skin
  • Provide cutaneous anesthesia as indicated
    • Ethyl chloride is typically sufficient
  • Injection
    • Prior to injection, use your knees to stabilize the patients leg so they do not flinch
    • Needle and syringe should be roughly parallel to the ground
    • Needle vector should be directed into the popliteal fossa
    • Advance needle approximately 1 inch into joint space, redirection may be required
    • Aspirate to ensure no blood return, then inject
    • Inject and if meeting resistance, pull back needle slowly until injection flows easily
  • After procedure, apply pressure to tamponade any bleeding
  • Apply bandage

Ultrasound Guided Technique

Short axis view of the suprapatellar recess with in-plane advancement of the needle tip.
  • Position
    • Patient is supine
    • Hip and knee are in extension in a neutral position
  • Ultrasound
    • Identify the suprapatellar recess in short axis using the linear probe
    • If no effusion is present, push on the suprapatellar tissue plane to identify the space
    • Mark your injection site on the skin
  • Sterilize the skin and apply a probe cover
  • Injection
    • Re-identify the suprapatellar recess with the ultrasound probe
    • Advance the needle into the suprapatellar recess
    • Note: you may need to use some sterile water or anesthetic to hydrodilate the recess
    • Once needle placement is confirmed, inject your other injectates
  • After procedure, apply pressure to tamponade any bleeding
  • Apply bandage

Aftercare

  • No major restrictions in most cases
  • Can augment with ice, NSAIDS

Complications

  • Infection
  • Damage to surrounding tissue

See Also


References

Created by:
Jesse Fodero on 14 July 2019 20:43:07
Last edited:
17 December 2022 09:25:33
Category: