Ultrasound-guided hip joint injection - Revision history

Mikael Häggström: /* Report */ + Information

2019-03-22T10:25:07Z

Report: + Information

Mikael Häggström: Delinked

2019-03-22T10:19:09Z

Delinked

Mikael Häggström: /* Planning */ +Information

2019-03-22T10:18:49Z

Planning: +Information

Mikael Häggström: /* Report */ Immediate

2019-03-22T10:06:24Z

Report: Immediate

Mikael Häggström: /* Report */ +Complications

2019-03-22T10:06:13Z

Report: +Complications

Mikael Häggström: +Evaluation

2019-03-22T10:02:20Z

+Evaluation

Mikael Häggström: Corrected

2019-03-22T09:11:00Z

Corrected

Mikael Häggström: Out of scope

2019-03-22T06:12:58Z

Out of scope

Mikael Häggström: /* Procedure */ Format

2019-03-21T17:39:45Z

Procedure: Format

Mikael Häggström: /* Procedure */ px

2019-03-21T17:38:24Z

Procedure: px

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 *Even the absence of hip effusion
 *Even the absence of joint capsule thickening or hyperemia
 {{Reporting}}
 {{Bottom}}

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 ===Patient information===
-In osteoarthritis patients, at least when not having had repeated injections, inform that the local anesthetic effect will wear off after about 4 to 6 hours, and it will take 2 to 7 days before the glucocorticoid will take effect, so that there may be increased pain in the meantime.<ref name=MedlinePlus>{{cite web|url=https://medlineplus.gov/ency/article/007633.htm|title=Hip joint injection|author=Benjamin Ma|accessdate=2019-03-22|website=[[MedlinePlus]] ([[United States National Library of Medicine]])}} Review Date 11/27/2016</ref>
+In osteoarthritis patients, at least when not having had repeated injections, inform that the local anesthetic effect will wear off after about 4 to 6 hours, and it will take 2 to 7 days before the glucocorticoid will take effect, so that there may be increased pain in the meantime.<ref name=MedlinePlus>{{cite web|url=https://medlineplus.gov/ency/article/007633.htm|title=Hip joint injection|author=Benjamin Ma|accessdate=2019-03-22|website=MedlinePlus (United States National Library of Medicine)}} Review Date 11/27/2016</ref>
 ==Procedure==

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 *Glucocorticoid, for example:
 :*40mg triamcinolone (such as 1ml of 40 mg/ml)<ref name="AndersonHerring2013"/>
 ==Procedure==

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 ==Report==
 *Contents of injectate.
-*Absence of complications, or a description thereof.
+*Absence of immediate complications, or a description thereof.
 A more comprehensive report may also include:

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 ==Report==
 *Contents of injectate.
 A more comprehensive report may also include:

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 ==Procedure==
-*Perform a '''preliminary sonography''', including color Doppler of the area to be punctured, to define the relationship of adjacent neurovascular structures.<ref name="YeapRobinson2017"/>
+*Perform a '''preliminary sonography''', including color Doppler of the area to be punctured, to define the relationship of adjacent neurovascular structures.<ref name="YeapRobinson2017"/> Preferably, also evaluate the joint area for any joint effusion, or any thickening or hyperemia of the joint capsule.
 *Decide which '''approach''' to use. Two common anterior approaches are typically used both with the patient lying supine:
 [[File:Hip joint injection by anterior longitudinal approach.jpg|thumb|200px|Anterior longitudinal approach. An arrow parallel to the long axis of the transducer is drawn on the skin adjacent to the end of transducer where the needle will be introduced.<ref name="YeapRobinson2017"/>]]
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 *Perform '''sterile preparation''' of the entire injection field, including adjacent skin where the gel and probe are applied. Areas of superficial infection such as cellulitis or abscess should be avoided to prevent deeper spread.<ref name="YeapRobinson2017"/>
 *Using the previous mark, '''insert the needle''', directed toward the intended target. It can be done by a freehand technique,<ref name="YeapRobinson2017"/> but a needle guide may be used. Needles with a Birmingham Gauge of 22–24 are sufficed for most injections.<ref name="YeapRobinson2017"/>
 {{Bottom}}

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 :*30mg mepivacaine (such as 3 ml of 1% Carbocaine)
 :*25mg bupivacaine (such as 5ml of Marcaine 0.5%)<ref name="AndersonHerring2013">{{cite journal|last1=Anderson|first1=Erik|last2=Herring|first2=Andrew|last3=Bailey|first3=Caitlin|last4=Mantuani|first4=Daniel|last5=Nagdev|first5=Arun|title=Ultrasound-guided Intraarticular Hip Injection for Osteoarthritis Pain in the Emergency Department|journal=Western Journal of Emergency Medicine|volume=14|issue=5|year=2013|pages=505–508|issn=1936900X|doi=10.5811/westjem.2013.2.13966}}</ref>
-*Cortisone, for example:
+*Glucocorticoid, for example:
 :*40mg triamcinolone (such as 1ml of 40 mg/ml)<ref name="AndersonHerring2013"/>

← Older revision		Revision as of 06:12, 22 March 2019
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−	[[File:Hip prosthesis components.jpg\|thumb\|160px\|Main components of a hip prosthesis<ref>{{cite web\|url=http://illumin.usc.edu/61/total-hip-replacement/\|title=Total Hip Replacement\|website=University of Southern California\|author=Andrew Still\|date=2002-11-02\|accessdate=2017-01-05}}</ref>]]
	{{Top		{{Top
	\|author1=[[User:Mikael Häggström\|Mikael Häggström]]		\|author1=[[User:Mikael Häggström\|Mikael Häggström]]

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 *Perform a '''preliminary sonography''', including color Doppler of the area to be punctured, to define the relationship of adjacent neurovascular structures.<ref name="YeapRobinson2017"/>
 *Decide which '''approach''' to use. Two common anterior approaches are typically used both with the patient lying supine:
-[[File:Hip joint injection by anterior longitudinal approach.jpg|thumb|left|200px|Anterior longitudinal approach. An arrow parallel to the long axis of the transducer is drawn on the skin adjacent to the end of transducer where the needle will be introduced.<ref name="YeapRobinson2017"/>]]
+[[File:Hip joint injection by anterior longitudinal approach.jpg|thumb|200px|Anterior longitudinal approach. An arrow parallel to the long axis of the transducer is drawn on the skin adjacent to the end of transducer where the needle will be introduced.<ref name="YeapRobinson2017"/>]]
 :*The '''anterior longitudinal''' approach: the probe is aligned along the long axis of the femoral neck. The needle is introduced from an anteroinferior approach and is passed into the anterior joint recess at the femoral head-neck junction.
 :*The '''anterolateral approach''', with the ultrasound probe oriented axially and the femoral head and acetabular rim in view. This often shortens the distance from needle skin entry to joint compared to the longitudinal approach making it a useful approach in larger patients. The introduced needle remains lateral to the femoral neurovascular bundle, and the needle is advanced until its tip rests on the femoral head.
-[[File:Ultrasonography of hip joint injection by anterolateral approach.jpg|thumb|Anterolateral approach, here shown as a transverse image. The needle will rest on the femoral head (arrow). A, acetabulum; H, femoral head; N, femoral neck; LAT, lateral; MED, medial.<ref name="YeapRobinson2017"/>]]
+<gallery mode=packed heights=200>
 *'''Draw''' a line parallel to the long axis of the transducer, on the skin adjacent to the end of the transducer is where the needle will be introduced.
 *Perform '''sterile preparation''' of the entire injection field, including adjacent skin where the gel and probe are applied. Areas of superficial infection such as cellulitis or abscess should be avoided to prevent deeper spread.<ref name="YeapRobinson2017"/>