Small Peripheral Joint Injections

[Louisville04]

How common is it for physiatrists to do hand injections (De Quervain's tenosynovitis, carpal tunnel syndrome, arthritis, trigger finger)? Is this something that should be deferred to orthopods since they have more training/experience?

On another note, I know joint prostheses are contraindications for injections. What if a patient had an ACL repair done 20 years ago and the x-ray shows a screw from the proximal tibia to the distal femur, would this be a contraindication?

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[eljefe]

How common is it for physiatrists to do hand injections (De Quervain's tenosynovitis, carpal tunnel syndrome, arthritis, trigger finger)? Is this something that should be deferred to orthopods since they have more training/experience?

On another note, I know joint prostheses are contraindications for injections. What if a patient had an ACL repair done 20 years ago and the x-ray shows a screw from the proximal tibia to the distal femur, would this be a contraindication?

Those are common injections. I'd love to see a picture of this screw...

 

[PMR 4 MSK]

How common is it for physiatrists to do hand injections (De Quervain's tenosynovitis, carpal tunnel syndrome, arthritis, trigger finger)? Is this something that should be deferred to orthopods since they have more training/experience?

On another note, I know joint prostheses are contraindications for injections. What if a patient had an ACL repair done 20 years ago and the x-ray shows a screw from the proximal tibia to the distal femur, would this be a contraindication?

1) common - we do them all the time
2) screw is not a contraindication to joint injection, but if it is crossing the joint, WTF is it doing there?

 

[Ludicolo]

How common is it for physiatrists to do hand injections (De Quervain's tenosynovitis, carpal tunnel syndrome, arthritis, trigger finger)? Is this something that should be deferred to orthopods since they have more training/experience?

Says who?

 

[SSdoc33]

for the ACL repair you have 2 screws. one in the prox tib, one in the distal femur, with the ACL in the joint in between. the screw shouldnt cross the joint itself.

you CAN do small joint injections. you CAN do a lot of hand work. most physiatrists dont, but if thats you niche, why not?

 

[sblau001]

I usually perform a few US-guided finger or hand joint injections a month. Not that it's a focus of my practice but patients with arthritis will actually request it.

 

[DOctorJay]

Here at Mayo we have a dedicated Hand rotation in PM&R. We see many hand related issues and use ultrasound guidance for injections.

Patients out in the real world typically have two options, hand surgeon, hand therapist - physiatrists can fill in the huge gap and I imagine working as a partner with a hand surgeon would be a great niche practice (EMGs for carpal tunnel/upper extremity issues, peripheral joint injections, CMC arthritis, ultrasound guided Dupuytren's release...).

 

[Louisville04]

for the ACL repair you have 2 screws. one in the prox tib, one in the distal femur, with the ACL in the joint in between. the screw shouldnt cross the joint itself.QUOTE]

Yes that makes sense. The way the radiologist dictated, it seemed like one screw.

Here is the A-P x-ray.

 

[PMR 4 MSK]

for the ACL repair you have 2 screws. one in the prox tib, one in the distal femur, with the ACL in the joint in between. the screw shouldnt cross the joint itself.QUOTE]

Yes that makes sense. The way the radiologist dictated, it seemed like one screw.

Here is the A-P x-ray.

No contraindication to injecting that joint.

Theres probably some older orthos that would freak out (we have one in our practice that would), but most wouldn't worry.

 

[RUOkie]

for the ACL repair you have 2 screws. one in the prox tib, one in the distal femur, with the ACL in the joint in between. the screw shouldnt cross the joint itself.QUOTE]

Yes that makes sense. The way the radiologist dictated, it seemed like one screw.

Here is the A-P x-ray.

that is 2 screws

As to the original post: I inject hands all the time.