Joint Injection

Assessment & Plan Elements, Musculoskeletal & Rheumatology, Procedure Note
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[checkbox name="Q0" value="Consent"][comment memo="<-- Include consent blurb?"][conditional field="Q0" condition="(Q0).is('Consent')"]
[textarea default="After discussion of the risks, benefits and alternative therapies available, the patient elected to proceed. After obtaining informed consent, the patient's identity, procedure, and site were verified during a pause prior to proceding with the minor surgical procedure as per universal protocol recommendations. "][/conditional]
[select name="Q1" value="Shoulder injection|Shoulder subacromial injection|Knee injection|Knee Synvisc injection|Trochanteric bursa injection|Trigger point injection|Ganglion cyst aspiration"]
[conditional field="Q1" condition="(Q1).is('Shoulder injection')"][textarea default="The shoulder was prepped x 3 with Betadine. The area of maximal tenderness was identified. Using a 27-gauge needle, the glenohumeral joint was entered. The mixture of lidocaine and Kenalog was easily inserted into the joint. The patient had mild to moderate relief of symptoms immediately post procedure indicating proper placement. There were no complications. Patient tolerated the procedure well."][/conditional][conditional field="Q1" condition="(Q1).is('Shoulder subacromial injection')"][textarea default="Arm was placed in a comfortable dependant position dangling at side with patient sitting comfortably. Entry site for injection of the subdeltoid bursa was identified by palpation and marked with tip of closed pen. Chlorhexidine scrub was used for prep. Using a 25 g 1 1/2" needle, a mixture of 4 ml Bupivicaine 0.5% and 1 ml of DepoMedrol 40 was injected without resistence. Patient tolerated well; there was no bleeding. Bandaid applied"][/conditional][conditional field="Q1" condition="(Q1).is('Knee injection')"][textarea default="Area of medial knee was cleansed with providone swabs. 6 cc's of 2:1 mixture of 2% lidocaine and 40 Kenalog was injected into the infrapatellar space with a 25g 1 ¼ inch needle. There were no complications."][/conditional][conditional field="Q1" condition="(Q1).is('Knee Synvisc injection')"][textarea default="With the patient lying in the supine position, the knee was flexed to 45 degrees, cleaned and prepped in the usual sterile manner. Using a 1.5-inch, 22-gauge needle, the pre-packaged Synvisc material was injected after negative aspiration. A sterile dressing was applied. The patient tolerated both procedures well. Lot number Exp"][/conditional][conditional field="Q1" condition="(Q1).is('Trochanteric bursa injection')"][textarea default="Patient was placed with affected side up for trochanteric bursal injection. Area over the trochanteric bursa was cleansed with chlorhexidine after identification of the bursal location which also corresponded to the point of maximal pain. The bursa was entered using a 25 g needle after advancing to bone and withdrawing slightly. A mixture of 0.5 ml of DepoMedrol 40 and 2 ml of 2% Lidocaine were injected with half of the mixture directly at point of maximal pain and 1/2 in fan-like fashion. Patient tolerated well; there was no bleeding. Bandaid applied."][/conditional][conditional field="Q1" condition="(Q1).is('Trigger point injection')"][textarea default="1.0 cc of a 1:1 mixture of 2% lidocaine/0 .5% Marcaine was injected with a 27-gauge 1.25-inch needle into several muscles in the upper left shoulder/back area as well as in the neck. Muscles isolated were the rhomboideus major/minor, trapezius, splenius capitis, sternocleidomastoid. There were no complications."][/conditional][conditional field="Q1" condition="(Q1).is('Ganglion cyst aspiration')"][textarea default="Area of dorsal left/right wrist was cleansed with alcohol swabs. 0.5 cc's of 1% lidocaine was injected into the dermis covering the ganglion cyst and then into the ganglion cyst. An 18-gauge needle attached to a 5 cc syringe was then used to aspirate the ganglion cyst. Hemostasis was obtained by pressure. There were no complications."][/conditional
<-- Include consent blurb?

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