The choice of injection portal is either superolateral under the patella with the knee extended or through the inferomedial or inferolateral soft part of the knee with the knee flexed to 90 degrees. Always use an aseptic technique.
Insert the needle into the knee joint.
A needle is then inserted into the joint to inject the medication or remove fluid from the knee. Often the doctor will inject with the patient lying flat and the knee straight, while the needle is placed from the outside, under the kneecap. Other injection sites may also be used.
The needle is inserted just below the patella on the medial or lateral side of the patellar tendon and directed toward the center of the knee joint. Before the needle is inserted, the selected injection spot is marked and cleaned before the procedure. Every precaution is taken to keep the area clean/sterile.
Insert an 18-gauge needle 3-4 mm below the midpoint of either the medial or the lateral border of the patella (see the image below). Direct the needle perpendicular to the long axis of the femur and toward the intercondylar notch of the femur. Left-knee aspiration via medial parapatellar approach.
You'll likely receive a cortisone shot, also called a steroid injection, as a first-line treatment. Cortisone shots are effective for many patients in quickly reducing inflammation and pain directly inside the joint, but they come with a few precautions.
The choice of injection portal is either superolateral under the patella with the knee extended or through the inferomedial or inferolateral soft part of the knee with the knee flexed to 90 degrees. Always use an aseptic technique. You do not need to aspirate the knee first unless there is a large effusion.
SYNVISC is a viscosupplement injection that supplements the fluid in your knee to help lubricate and cushion the joint, and can provide up to six months of osteoarthritis knee pain relief with three injections.
You may feel slight pain or discomfort as the needle goes into the joint. However, taking the fluid out of the knee should not be painful. In addition, using ultrasound improves the accuracy of needle placement and reduces procedure discomfort.
Your doctor may do it to help with swelling and fluid related to an injury, infection, or another health condition. Joint aspiration can also help to diagnose arthritis or other joint problems. Your doctor looks at the fluid to find out what type of arthritis you have, like gout or rheumatoid arthritis.
It is recommended that you refrain from any high level activities using your knee for approximately 48 hours. Routine activities including walking are permitted. The most commonly reported side effects are temporary pain, swelling and/or fluid accumulation in the injected knee.
Hyaluronic acid injection is used to treat knee pain caused by osteoarthritis (OA) in patients who have already been treated with pain relievers (e.g., acetaminophen) and other treatments that did not work well.
Additionally, the majority of patients felt safe to drive following the injection. Thus, driving may be considered safe following intra-articular injection for knee osteoarthritis.
PHE (2013) advised that if you are physically clean and in good general health then swabbing prior to injecting is not required. Where to inject The easiest site when self-administering an IM injection is the middle third of the vastus lateralis muscle of the thigh.
The clinical picture suggests that the needle pierced the nerve during the procedure. This complication should be considered when performing knee joint injection, especially when the patient is obese and the anatomic landmarks are obscured. Aseptic acute arthritis can develop within hours after injection13.
Hylauronic acid is a substance that is naturally present in joints, and functions as a lubricant and a shock absorbent. The idea behind these injections is that they will temporarily restore the natural function of the knee by injecting a substance which will provide cushioning and reduce bone-on-bone contact.
Knee Injections Side Effects
Side effects for both types of injections are relatively minimal. Patient's can expect some initial soreness and pain at the injection site which should subside in 24-48 hrs. Patients with diabetes may note a temporary rise in blood sugar levels for 48-72 hrs after cortisone injections.
After an injection, your joint may feel better for several months –sometimes as long as a year. Some people get increased pain and swelling in their joint immediately after having the injection. This pain tends to go away after a few days.
The most severe sprain classification, a grade III sprain involves a complete tear of a ligament. In some cases, the ligament may separate from the bone. Swelling and bruising may be severe and it may be difficult or impossible to put weight on the affected leg.
Such tests include the anterior drawer test, the posterior drawer test, the valgus stress test, and the varus stress test.
INSPECTION AND PALPATION
The knee is then palpated and checked for pain, warmth, and effusion. Point tenderness should be sought, particularly at the patella, tibial tubercle, patellar tendon, quadriceps tendon, anterolateral and anteromedial joint line, medial joint line, and lateral joint line.
Medicare will cover knee injections once every six months if they are medically necessary. The injections are covered under Medicare Part B and subject to the annual Part B deductible. X-rays are required prior to Medicare approval. As mentioned above, there are many different injection treatments for the knees.
Generally, use cortisone for a sore, swollen knee. Hyaluronic acid or Platelet-rich plasma is our preferred long-term choice. Finally, you should always perform injections with ultrasound to make it more accurate.