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IMAGE-GUIDED PERIPHERAL JOINT INJECTION INDICATIONS

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The most common clinical indication for an image-guided interventional procedure is pain in the targeted anatomic location, which has either failed other conservative treatments or as an adjunctive treatment. The primary advantage of image-guided interventional procedures over blind injections includes needle placement confirmation and the ability to view the targeted area and relevant anatomy.

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Corticosteroid injections are frequently used as conservative treatments in the management of various conditions, including osteoarthritis, tendonitis, bursitis, and impingement conditions. Injectate mixtures typically comprise a local anesthetic and a corticosteroid (triamcinolone or methylprednisolone). In addition, patients at higher risk for developing nonsteroidal anti-inflammatory drug (NSAID)–induced renal dysfunction or gastric and duodenal ulcers are candidates for intra-articular steroid injections to avoid the potential systemic effects that occur with oral anti-inflammatory medications. However, the detrimental effects of repeated steroid injections on soft tissue structures like articular cartilage and tendons have not yet been determined.

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The advantages of ultrasound-guided percutaneous interventional procedures are as follows:

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  • Real-time assessment

  • Guidance, and continuous needle visualization

  • Lack of radiation exposure

  • Technological portability

  • Relatively low cost

  • Improved accessibility

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Fluoroscopic guidance also allows real-time needle visualization and the acquisition of imaging frames throughout the injection course. The visualization occurs at different C-arm angles. The primary disadvantage of fluoroscopy is radiation exposure to both the patient and physician.

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BASIC CONCERNS AND CONTRAINDICATIONS

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With therapeutic interventions, the benefits and risks of the procedure must be considered. Generally, peripheral joint corticosteroid injections are considered to be safe and conservative treatments. However, each patient’s risk factors for complications must be carefully considered prior to undergoing the procedure.

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Some basic concerns for injection are following:

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  • Patients with primary or metastatic tumors in the target area

  • Immunocompromised patients, who are at increased risk for infection

  • Patients with thrombocytopenia

  • Patients who may be unable to tolerate positioning

  • Patients with allodynia or complex regional pain syndrome (CRPS), who will be unable to tolerate the procedure

  • Patients on anticoagulant medications, who have been unable to stop these medications at an appropriate time interval

  • For fluoroscopically guided procedures with the use of contrast dye, patients with allergies to contrast, shellfish, or iodine may be considered for interventional procedures without contrast

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Contraindications for injection include:

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  • Infection, systemic or localized

  • Coagulopathy

  • Distorted or complicated anatomy

  • Pregnancy for fluoroscopically guided procedures

  • Patient refusal

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GENERAL IMAGE-GUIDED INTERVENTIONAL PROCEDURE PREOPERATIVE CONSIDERATIONS

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  • Informed consent must be obtained and the risks and benefits of the procedure should be properly explained to the patient or consenting individual.

  • The area must be examined for infection, skin lesions, and disease extent.

  • Proper exposure of the targeted area is necessary. If clothing is restrictive, the patient should be requested to change into a gown.

  • Ideally, the patient should be able to remain in the appropriate ...

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