We reviewed the procedure of joint aspiration and injection and discussed the risks, benefits, and alternative treatments. Informed consent was obtained as outlined below. I verified that the patient had no allergies to local anesthetic. We discussed the potential side effects of corticosteroids, including but not limited to local tissue breakdown, elevation of blood sugar and seizures.
A procedural pause was conducted to verify correct patient identity, procedure to be performed, correct side and site, correct patient position, availability of implants, and need for special equipment or special requirements. After verification, the [select value="side|right|left"] [select value="joint|shoulder|knee"] was marked and then prepped in the usual sterile fashion. Using a 22 gauge 1.5 inch needle, 4 mL of lidocaine and [select value="steroid|triamcinolone - 40 mg (intermediate acting)|methylprednisolone - 40 mg (intermediate acting)|betamethasone - 6 mg (long acting)"] was injected into the joint space without difficulty. After injection, the joint was passively moved through the full range of motion and a sterile dressing was applied. The patient tolerated the procedure well. Aftercare discussed."]
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reference: <a href="http://www.aafp.org/afp/2003/0315/p1271.html" target="_blank">Tallia (2003) Am Fam Physician 67(6):1271-8</a>, <a href="http://www.aafp.org/afp/2002/1015/p1497.html" target="_blank">Zuber (2002) Am Fam Physician 66(8):1497-1501</a>, <a href="http://www.fpnotebook.com/Rheum/Procedure/JntInjctn.htm" target="_blank">FP Notebook</a>.[/html][/conditional]