Small Joint Infiltration: an alternative treatment for hand and feet pain

 

 Small Joint inflammation dr roque1






  • Injection of joints, bursae, tendon sheaths, and soft tissues of the human body is a useful diagnostic and therapeutic procedure. 
  • These injections are most useful in instances of joint or tissue injury and inflammation. 
  • Joint pain may simply be painful(arthralgia) or also inflamed(arthritis)
  • There are more than 100 different types of arthritis



Pain in the small joints can affect any joint, especially if the patient is suffering from inflammatory conditions such as rheumatoid arthritis or any other commonly known connective tissue disorders.   Arthritis is an inflammation of the joints. It can affect one joint or multiple joints. There are more than 100 different types of arthritis, with different causes and treatment methods. Two of the most common types are osteoarthritis (OA) and rheumatoid arthritis (RA).

 

 

substantial practice-based experience supports the effectiveness of joint and soft tissue injection for many common problems. Most inflammatory condition can be treated with  Fluoroscopic Guided– image infiltrations.
 
 When the inflammation affects the  hand or fingers, the patient might  complain about the following:



*Small joint inflammation is usually accompanied by warmth, swelling (caused by intra-articular fluid or infusion), and uncommonly erythema. Pain may occur during movement or at rest.

*Finger paint mostly on the little joints of the fingers, hand pain or swelling and stiffness. 

*The small joints of the hand and fingers could be warm and tender to touch

*Redness of the skin around the joint

*The range of motion may be decreased 

*The finger joints or hand joints can be deformed. 

*Fatigue

*Carpal tunnel symptoms such as numbness, tingling, and burning of the hands.

*Waking or morning pain with a stiffness that lasts for a long time. Many people with arthritis notice their symptoms are worse in the  morning

 



      How is arthritis diagnosed? 

  •  The Physical examination is essential in any evaluation of small joint pain. 
  • Your physician normally will check for the skin around the joints, warm or red joints, and limited range of emotions of joints. 
  • Your physician might refer you to a specialist if needed.
  • A blood test is done to evaluate the elements associated with inflammation along with join fluid examination, helping in the determination of your arthritis. 
  • The blood tests check for specific types of antibodies like rheumatoid factor(RF), antinuclear antibodies(ANA).
  • Imaging studies are part of the initial evaluation and normally include x-rays, MRIs, CT scans.

 

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Indications for Diagnostic and Therapeutic Injection

  • Soft tissue conditions
  • Bursitis
  • Tendonitis or tendinosis
  • Trigger points
  • Ganglion cysts
  • Neuromas
  • Entrapment Syndromes
  • Fasciitis
  • Joint conditions
  • Effusion of unknown origin or suspected infection (only diagnostic)
  • Crystalloid arthropathies
  • Synovitis
  • Inflammatory arthritis
  • Advanced osteoarthritis

These injections are most useful in instances of joint or tissue injury and inflammation. 
History of pain, local and referred, will provide important clues to the underlying pathology condition.
The indications for joint or soft tissue aspiration and injection fall into two categories: diagnostic and therapeutic. A common diagnostic indication for placing a needle in a joint is the aspiration of synovial fluid for evaluation. Synovial fluid evaluation can differentiate among various joint disease etiologies including infection, inflammation, and trauma. A second diagnostic indication involves the injection of a local anesthetic to confirm the presumptive diagnosis through symptom relief of the affected body part.
Therapeutic indications for joint or soft tissue aspiration and injection include decreased mobility and pain, and the injection of medication as a therapeutic adjunct to other forms of treatment. Caution must be exercised when removing fluid for pain relief because of the possibility of introducing infection and precipitating further or new bleeding into the joint. Also, early reaccumulation of fluid can occur in many cases.
Therapeutic injection with corticosteroids should always be viewed as adjuvant therapy. The improper or indiscriminate use of corticosteroids is likely to have a bad outcome. These injections should never be undertaken without a diagnostic definition and a specific treatment plan in place. Physicians should resist external pressure for a quick return of athletes to playing sports through the use of joint or soft tissue injections. 

Small Joint inflammation dr roque2




Possible Complications

A number of potential complications can arise from the use
of joint and soft tissue procedures. Local infection is always possible, but it can be avoided by following the proper technique. Joint injections should always be performed using
sterile
procedure to prevent septic arthritis. Local reactions at the injection site may include swelling, tenderness, and warmth, all of which may develop a few hours after injection and can last up to two days. A postinjection steroid flare, thought to be a crystal-induced synovitis caused by preservatives in the injectable suspension, may occur within the first 24 to 36 hours after injection
.This
is self-limited and responds to application of ice packs for no longer than 15-minute intervals.
Soft tissue (fat) atrophy and local depigmentation are possible with any steroid injection into soft tissue, particularly at superficial sites (e.g., lateral epicondyle). Periarticular calcifications are described in the literature, but they are rare. Tendon rupture can be avoided by not injecting directly into the tendon itself.
Systemic effects are possible (especially after triamcinolone acetonide [Aristocort] injection or injection into a vein or artery), and patients should always be acutely monitored for reactions. Alterations in taste have been reported for one to two days after steroid injection. Hyperglycemia is possible in patients who have diabetes.
To avoid direct needle injury to articular cartilage or local nerves, attention should be paid to anatomic landmarks and depth of injection. 



Postinjection Instructions and Care

An adhesive dressing should be applied to the injection site. To minimize pain and inflammation after leaving the office, the patient should be advised to apply ice to the injection site (for no longer than 15 minutes at a time, once or twice per hour), and non-steroidal anti-inflammatory agents may be used, especially for the first 24 to 48 hours. The affected area should be rested from strenuous activity for several days after the injection because of the small possibility of local tissue tears secondary to temporarily high concentrations of steroid. This risk lessens as the steroid dissipates. Patients should be educated to look for signs of infection including erythema, warmth, or swelling at the site of injection, or systemic signs including fever and chills. The patient should keep the injection site clean and may bathe.




Conclusion

 

Substantial practice-based experience supports the effectiveness of joint and soft tissue injection for many common problems.
These injections are most useful in instances of joint or tissue injury and inflammation. History of pain, local and referred, will provide important clues to the underlying pathology. Physical examination is extremely helpful in ascertaining the diagnosis. Knowledge of the anatomy of the area to be injected is essential. Injection of joints, bursae, tendon sheaths, and soft tissues of the human body is a useful diagnostic and therapeutic procedure. 

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