1. Aspiration and Injection of the Knee
Joseph J. Ruane, DO
Medical Director
Spine, Sport & Joint Center
Head Team Physician
Columbus Blue Jackets

2. DISCLOSURE The speaker and members of the planning committee do not have a conflict of interest in this topic. There is no commercial support for this program.

3. Intra-articular Corticosteroids: Possible Side-Effects
Tissue atrophy
Fat necrosis
Erythematous flushing of skin (chest and face)
Skin depigmentation
Uterine bleeding
Nerve damage
Charcot-like arthropathy ("steroid arthropathy”)
Posterior subcapsular cataracts
Pancreatitis (rare)
Cushing's (rare)
Fluid retention
Osteonecrosis (rare)
latrogenic infection (rare)
Tendon rupture (<1%)
Calcification (up to 40%)
Post-injection flare of symptoms (2-5%)

4. “Corticosteroid Injections Safe for Knee Osteoarthritis”
68 patients with knee OA
34 patients each received triamcinolone acetonide or saline, every 3 months for 2 years
Neither group showed disease progression; changes in the mean joint-space width were not significant
Ralnauld Je Buckland-Wright C, Ward R, et al, Safety and efficacy of long-term intraarticular steroid injections in osteoarthritis of the knee: a randomized, double-blind, placebo-controlled trial; Arthritis Rheum. 2003;48:

5. Steroid Side Effects
54 year old computer programmer with right knee pain
Increased pain while standing at work, climbing stairs, and he has noticed increased swelling lately

7. Aspiration and Injection of the Knee Review of Anatomy and Landmarks

8. Aspiration and Injection of the Knee
Supine Anatomy

9. Know what you are getting into!

16. Surface Landmarks - Supine
Knee photo

17. Aspiration and Injection of the Knee
Seated Anatomy

21. “No Knee”

22. Aspiration and Injection of the Knee
Supine Injection

23. Injections Should Not Hurt!

24. Injection Technique – Supine

25. Aspiration and Injection of the Knee
Seated Injection

26. Injection Technique – Seated

27. Aspiration and Injection of the Knee Special Considerations

28. Needle in Fat Pad

29. SP Fat Pad Clogging Needle

30. Repositioning the Needle31

31. Aspiration and Injection of the Knee
Questions?

32. Synovial Debris

33. Injection Technique CARDINAL RULES ALWAYS ASPIRATE
NEVER INJECT AGAINST RESISTENCE
ALWAYS KNOW YOUR ANATOMY
NEVER FORGET TO DISCUSS SIDE EFFECTS

34. Aspiration of Effusion

35. Effusion: Color Enhanced MRI

36. Aspiration Sequence

37. “Junk in the Joint”

38. Debris Clogging Needle

39. Clearing Debris from Needle

40. Tenting

42. “Synovial Tenting”

43. Extracapsular Injection
With the extracapsular injection, there was:
No aspiration of joint fluid
No air bubble drawn into syringe
Mild discomfort with initial bolus of Omnipaque

44. Physical Examination

45. Injection Technique

46. Extracapsular Injection

47. Fat Pad Injection

48. Othopedic Residency

51. Men Baby Sitting

52. Injection of the Shoulder

53. Anatomy and Landmarks

54. Anatomy and Landmarks

55. Anatomy and Landmarks

60. The Subacromial Bursa

61. SA Space – Posterior Approach

62. Posterior Injection

64. To the lab… Questions?

65. SA Space – Lateral Approach

66. Subacromial Injection

67. SAB Injection