Injection Procedures

Todd P. Stitik Editor Injection Procedures Osteoarthritis and Related Conditions

Editor Todd P. Stitik Professor, Physical Medicine and Rehabilitation Co-Director, Musculoskeletal/Pain Management Fellowship Director, Occupational/Musculoskeletal Medicine Co-Director, Interventional Spine Injection Clinic Department of Physical Medicine and Rehabilitation New Jersey Medical School Newark, NJ, USA todd.stitik@gmail.com ISBN 978-0-387-76594-5 e-isbn 978-0-387-76595-2 DOI 10.1007/978-0-387-76595-2 Springer New York Dordrecht Heidelberg London Library of Congress Control Number: PCN applied for Springer Science+Business Media, LLC 2011 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com)

I dedicate this book to my wife, Rossana, and children, Jeanette ( Jenna ) and Luke, whose patience, understanding, sacrifice, and support were greatly appreciated and necessary for the project to be completed. Without them in my life, this book would not have been written.

Preface It has been my belief, ever since I was a resident physician and performed my first musculoskeletal injection procedure (a carpal tunnel injection for a patient whom I had diagnosed by EMG testing with carpal tunnel syndrome), that better instructional material was needed for musculoskeletal medicine injection procedures. I recall in preparing for that injection that I had to refer to several different sources of information. Despite this, not one source adequately explained the entire procedure in a practical step-by-step fashion that also included helpful clinical pearls and pitfalls, and none of the sources provided me with a template that I could use to document the procedure in the medical record. The patient s gratitude when the injection subsequently greatly relieved his symptoms helped to convince me that I wanted to develop a musculoskeletal medicine practice with an emphasis on officebased injection procedures. After struggling to learn and perform several other injection procedures while I was still a resident, I began to wonder why office-based musculoskeletal medicine injection procedures in general were not being performed at that time using some form of image guidance. It was my belief that image guidance could help with injection accuracy and that this would likely translate into better clinical results and help to minimize patient s discomfort and side effects. It is hard to prove with certainty for most procedures that the increased accuracy associated with image guidance compared to blind injection procedures results in better outcomes. However it is tough to deny that an image-guided injection procedure, that does not result in pain relief, more convincingly excludes the structure as a pain generator compared to lack of a beneficial response after a nonimage-guided injection. When I began to teach musculoskeletal medicine, I quickly learned to enjoy the inevitable look of interest on the faces of the students, residents, and fellows when they witnessed a particular injection procedure for the first time. This interest is then usually replaced with a look of satisfaction and sometimes exhilaration when they eventually successfully perform a procedure themselves. I also found that good and sometimes detailed procedural documentation is very important with respect to patient care (particularly for repeat procedures since a procedure note that documents any nuances encountered during a procedure will usually help guide future procedures on the same patient) and reimbursement and can be helpful in situations of alleged malpractice. However, any busy clinician can vii

viii Preface relate to the dilemma that is often posed by the desire to adequately document a procedure and the reality of significant time limitations. Through these experiences with learning, performing, and then teaching musculoskeletal medicine injection procedures, I decided to someday attempt to write a comprehensive injection textbook with an emphasis on image guidance. When I finally and firmly committed to undertaking this project, it was clear to me that the field of musculoskeletal medicine was rapidly moving in the direction of image guidance as a tool for improving injection procedures. During the subsequent years during which this book has been written, the trend of image guidance has accelerated even more, particularly with the advent of musculoskeletal ultrasound into mainstream medicine in the USA. This trend further convinced me of the need for a text that emphasized image guidance. In summary, this musculoskeletal medicine injection text has several purposes: to discuss as many of the different procedures as possible, reference the literature, instruct the physician in a step-by-step manner on how to perform the injection using images (not just drawings) from procedures performed on actual or simulated patients wherever possible, teach useful clinical pearls and warn of pitfalls, and provide ready-made documentation templates that could be adapted to a given clinical practice for the medical record. It was therefore my overall goal that this book would be much more than just an instructional manual on how to perform an injection. I hope that this has been achieved. Newark, NJ Todd P. Stitik

Acknowledgments The following pharmaceuticals are often cited in the Procedure Instructions and the Injection Procedure Templates in Chaps. 6 12. As a space-saving device, the manufacturer, city, state/province, country are noted herewith instead of in the Instructions and Templates: Betadine (Purdue-Pharma LP, Stamford, CT, USA) Depo-Medrol (Pfizer, New York, NY, USA) MyoJect (VIASYS Healthcare, San Diego, CA, USA) Omnipaque (GE Healthcare, Waukesha, WI, USA) ix

Contents Part I Introduction to Injection Procedures and Related Topics 1 Basic Principles of Joint and Soft Tissue Injection Procedures... Todd P. Stitik, Jong H. Kim, and Gregory Gazzillo 3 2 Pharmacotherapy of Joint and Soft Tissue Injections... Todd P. Stitik, Ajay Kumar, Jong H. Kim, Jiaxin J. Tran, and Charles Lee 33 3 Viscosupplementation... Todd P. Stitik, Jong H. Kim, Gregory Gazzillo, and Charles Lee 67 4 Low Back Pain: Considerations of When to Refer Patients for Interventional Spine Procedures... Eric L. Altschuler, Brian F. White, Todd P. Stitik, and Jong H. Kim 91 5 Adminstrative Aspects of Office-Based Injection Procedures... 101 Charles Sara, Jeffrey J. Fossati, Gregory J. Mulford, and Lisa Schoenherr Part II Upper Limb Injection Procedures 6 The Shoulder... 133 Todd P. Stitik, Jong H. Kim, Michael J. Mehnert, Mohammad Hossein Dorri, Jose Ibarbia, David J.VanWhy, Lisa Schoenherr, Naimish Baxi, Ladislav Habina, and Jiaxin J. Tran 7 The Elbow... 213 Peter P. Yonclas, Michael J. Mehnert, Todd P. Stitik, Mohammad Hossein Dorri, Jong H. Kim, David J.Van Why, Jose Ibarbia, Lisa Schoenherr, Naimish Baxi, Ladislav Habina, and Jiaxin J. Tran xi

xii Contents 8 The Wrist... 245 Patrick M. Foye, Debra S. Ibrahim, Michael J. Mehnert, Todd P. Stitik, Jong H. Kim, Mohammad Hossein Dorri, David J. Van Why, Jose Ibarbia, Lisa Schoenherr, Naimish Baxi, Ladislav Habina, and Jiaxin J. Tran 9 The Hand... 281 Patrick M. Foye, Debra S. Ibrahim, Michael J. Mehnert, Todd P. Stitik, Jong H. Kim, Mohammad Hossein Dorri, David J. Van Why, Jose Ibarbia, Lisa Schoenherr, Naimish Baxi, Ladislav Habina, and Jiaxin J. Tran Part III Lower Limb Injection Procedures 10 The Hip... 315 Patrick M. Foye, Christopher Castro, Todd P. Stitik, Jong H. Kim, Mohammad Hossein Dorri, Jose Santiago Campos, Lisa Schoenherr, Naimish Baxi, and Ladislov Habina 11 The Knee and Its Region... 347 Todd P. Stitik, Jong H. Kim, Christopher Castro, Mohammad Hossein Dorri, Jose Santiago Campos, Lisa Schoenherr, Naimish Baxi, and Ladislov Habina 12 The Ankle and the Foot... 397 Patrick M. Foye, Christopher Castro, Peter P. Yonclas, Todd P. Stitik, Mohammad Hossein Dorri, Jong H. Kim, Jose Santiago Campos, Lisa Schoenherr, Naimish Baxi, and Ladislav Habina Index... 437

Contributors Eric L. Altschuler Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Newark, NJ, USA Naimish Baxi New Jersey Medical School, Newark, NJ, USA Jose Santiago Campos Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Newark, NJ, USA Christopher Castro Northeastern Rehabilitation Associates, Bethlehem, PA, USA Mohammad Hossein Dorri Department of Physical Medicine and Rehabilitation, New York College of Medicine, New York, NY, USA Jeffrey J. Fossati Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Hackensack, NJ, USA Patrick M. Foye Department of Medicine and Rehabilitation, New Jersey Medical School, Newark, NJ, USA Gregory Gazzillo Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA Ladislav Habina, Jr. Department of Pain and Rehabilitation Center, Seton Hall University, South Orange, NJ, USA Jose Ibarbia Department of Rehabilitation Medicine, New York Presbyterian Hospital, Columbia University Medical Center and Weill Cornell Medical Center, New York, NY, USA xiii

xiv Contributors Debra S. Ibrahim New Jersey Medical School, Newark, NJ, USA Jong H. Kim Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Newark, NJ, USA Ajay Kumar Physiatrist and Interventional Pain Specialist, Private Practice, East Stroundsburg, PA, USA Charles Lee New York College of Podiatric Medicine, New York, NY, USA Michael J. Mehnert Department of Physical Medicine and Rehabilitation, Rothman Institute, Thomas Jefferson Medical School, Philadelphia, PA, USA Gregory J. Mulford Department of Rehabilitation Medicine, Atlantic Health Morristown Memorial Hospital, Morristown, NJ, USA Charles Sara Department of Physical Medicine and Rehabilitation, Northern NJ Pain & Rehab, Newark, Hackensack, USA Lisa Schoenherr Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Newark, NJ, USA Todd P. Stitik Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Newark, NJ, USA Jiaxin J. Tran New Jersey Medical School, Newark, NJ, USA David J. Van Why Department of Rehabilitation Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA Brian F. White Department of Surgery, Division of Physiatry, Bassett Medical Center, Cooperstown, NY, USA Peter P. Yonclas Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Newark, NJ, USA