Musculoskeletal Injections Manual: Basics, Techniques and Injectable Agents

Preface
Contents
Part I: Basics of Musculoskeletal Injections
	1: Philosophy of Musculoskeletal Injections
		1.1	 Introduction
		1.2	 Philosophy of Musculoskeletal Injections
		1.3	 Conclusion
		References
	2: The Evidence-Based Medicine for Injection Therapy
		2.1	 Introduction
		2.2	 Intra-Articular Injections
		2.3	 Extra-Articular Injections
		2.4	 Conclusion
		References
	3: Contraindications and Potential Side Effects of Injections
		3.1	 Introduction
		3.2	 Intra-Articular Effects
		3.3	 Surrounding Tissue Effects
		3.4	 Systemic Effects
		3.5	 Conclusion
		References
	4: Informing Patients
		4.1	 Possible Complications of Injections
		4.2	 Obtaining Consent from the Patient
		References
	5: Sterilization and Injection Materials
		5.1	 Introduction
		5.2	 Injection Equipment
		5.3	 Preparation of Injection Site
		References
	6: Things to Take into Consideration in Injection and Aspiration
		6.1	 Indication for Treatment
		6.2	 Settings
		6.3	 Medical History
		6.4	 Anatomical Landmarks
		6.5	 Minimize Risk of Infection
		6.6	 The Procedure
		6.7	 Conclusion
		References
	7: Postinjection Care and Education
		7.1	 Introduction
		7.2	 Immediate Aftercare
		7.3	 Dressing
		7.4	 Pressure and Cooling
		7.5	 Mobilization and Return to Activity
		7.6	 Postinjection Pain: General Complications
		7.7	 Postinjection Pain: Local Complications
		7.8	 Elective Surgery after Injection
		7.9	 Conclusion
		References
Part II: Non Biologic Agents for Injections
	8: Corticosteroids and Local Anesthetics
		8.1	 Background
			8.1.1	 Corticosteroids (CS)
			8.1.2	 Local Anesthetics (LA)
		8.2	 An Overview of the Indications
		8.3	 Contraindications
		8.4	 Complications
		8.5	 Applications of Corticosteroids and Local Anesthetic in the Knee Joint
		8.6	 Conclusion
		References
	9: Viscosupplementation Agents
		9.1	 Background
		9.2	 Mechanism of Action
		9.3	 Viscosupplementation Agents
		9.4	 Contraindications and Adverse Events
		9.5	 Evidence
		9.6	 Joint-Based Applications
			9.6.1	 Shoulder
			9.6.2	 Ankle
			9.6.3	 Knee
			9.6.4	 Hip
			9.6.5	 Hand
		9.7	 Conclusion
		References
	10: Radiosynovectomy
		10.1	 Introduction
		10.2	 Indications and Contraindications of Radiosynovectomy
		10.3	 Informed Concept and Procedure
			10.3.1	 Joints Specific Approaches and Needle Sizes for RSV
			10.3.2	 RSV in Rheumatoid Arthritis
			10.3.3	 RSV in Hemophilia
			10.3.4	 RSV in Osteoarthritis
		10.4	 Conclusion
		References
	11: Deproteinized Hemoderivative of Calf Blood-Natural Botanical and Mineral Extracts
		11.1	 Introduction
		11.2	 Most Used Deproteinized Hemoderivative of Calf Blood-Natural Botanical and Mineral Extracts
		11.3	 Conclusion
		References
Part III: Ortho-biologic Agents for Injections
	12: Orthobiologics: Background
		12.1	 Introduction
		12.2	 Types and Effects of Orthobiologics
		12.3	 Conclusion
		References
	13: Platelet-Rich Plasma for Osteoarthritis
		13.1	 Introduction
		13.2	 PRP Outcomes for OA
		13.3	 Application Protocol
		13.4	 Conclusion
		References
	14: Platelet-Rich Plasma Treatment for Meniscal Tears
		14.1	 The Anatomy of the Menisci
		14.2	 Meniscal Injuries and Rationale for Use of PRP
		14.3	 PRP Use for Meniscal Tears: Clinical Data
		14.4	 Conclusion
		References
	15: PRP in Tendinopathy
		15.1	 Introduction
		15.2	 Fundamentals of PRP in Tendinopathy
		15.3	 Role of Leukocytes in the Treatment of Tendinopathies with PRP
		15.4	 Leukocyte-Rich PRP and Leukocyte-Poor PRP in Tendinopathy
		15.5	 Importance of the Activation of the Inflammatory Process in the Use of PRP
		15.6	 Conclusion
		References
	16: Platelet-Rich Plasma (PRP) for Rotator Cuff Tears
		16.1	 Introduction
		16.2	 Healing Rotator Cuff Injuries with PRP Therapy
		16.3	 The Effectiveness of PRP for Rotator Cuff Tears
			16.3.1	 PRP Injections as Isolated Treatment for Rotator Cuff Tears
			16.3.2	 PRP as an Adjunct to Rotator Cuff Repairs
			16.3.3	 Effects on the Rotator Cuff’s Structural Integrity
		16.4	 Discussion
		16.5	 Conclusion
		References
	17: Platelet-Rich Plasma Treatment for Muscle Injuries
		17.1	 Introduction
		17.2	 Muscle Healing Pathophysiology and Rationale for Using PRP
		17.3	 Platelet-Rich Plasma for Muscle Injuries: Clinical Experience
		17.4	 Tips for PRP Use for Muscle Injuries
		17.5	 Conclusion
		References
	18: Bone Marrow Aspirate Concentrates for Knee OA
		18.1	 Introduction
			18.1.1	 Safety and Contraindications
		18.2	 Bone Marrow Tissue
			18.2.1	 Bone Marrow-Specific Regions
			18.2.2	 Bone Marrow Niches
			18.2.3	 Bone Marrow Aspiration
		18.3	 BMAC Procedural Preparations
			18.3.1	 BMA Harvesting Sites
			18.3.2	 Imaging Options
				18.3.2.1	 Ultrasound
				18.3.2.2	 Fluoroscopy
			18.3.3	 Cortical Bone Penetration Options
			18.3.4	 Anesthetic Considerations
			18.3.5	 BMA Harvesting Needle Devices
			18.3.6	 Anticoagulation with Heparin Solution
			18.3.7	 Extraction/Collection Syringes
			18.3.8	 BMAC Device Function
		18.4	 BMC Injection Knee Osteoarthritis
			18.4.1	 Background
			18.4.2	 Intra-articular Setup
		References
	19: Fat-Derived Orthobiologics for Knee OA
		19.1	 Introduction
			19.1.1	 Safety and Contraindications
		19.2	 Adipose Tissue Background
			19.2.1	 Adipose Tissue Structure
			19.2.2	 Adipose-Derived Tissue Stem Cells
			19.2.3	 Adipose Harvesting Technique Considerations
		19.3	 Preparation of Minimally Manipulated Products from Adipose Tissue
			19.3.1	 Adipose Tissue Concentrate
			19.3.2	 Micro-fragmented Adipose Tissue (MFAT)
			19.3.3	 Stromal Vascular Fraction (SVF)
			19.3.4	 SVF by Enzymatic Digestion
		19.4	 SVF by Mechanical Disruption
		19.5	 Adipose Tissue Orthobiological Properties
			19.5.1	 Immunomodulation
			19.5.2	 Angiogenesis
		19.6	 Adipose-Derived Products in Knee Osteoarthritis
		References
	20: Autologous Conditioned Serum (ACS)
		20.1	 Background
		20.2	 Mechanisms of Action
			20.2.1	 Inflammatory Modulation
			20.2.2	 Growth Factors and Cytokines
		20.3	 Clinical Applications, Indication, and Dosage of Autologous Conditioned Serum Therapy
			20.3.1	 Osteoarthritis
			20.3.2	 Tendinopathies
			20.3.3	 Ligament Injuries
			20.3.4	 Other Musculoskeletal Conditions
			20.3.5	 Epidural Peri-radicular Injection for Back Pain
		20.4	 Application of ACS
		20.5	 Side Effects and Contraindications
		20.6	 Future Perspectives and Conclusion
		References
	21: Alpha-2-Macroglobulin Concentrate as Orthobiologic in Osteoarthritis
		21.1	 Introduction
			21.1.1	 Safety and Contraindications
		21.2	 General Background A2M Protein Complex
			21.2.1	 Pharmacological Aspects A2M
			21.2.2	 Growth Factors, Cytokines, and A2M Application
		21.3	 Modulating Inflammation and Cartilage Degradation in OA
			21.3.1	 The Protective Effects of A2M in Synovial Fluid (SF)
		21.4	 Procedural Steps Producing A2M as Orthobiologic Injectate
			21.4.1	 Ultrafiltration Process
			21.4.2	 Clinical A2M Preparation Techniques
		21.5	 Clinical Data
		21.6	 Future Directions
		References
Part IV: Injections of Anatomical Regions and Diseases
	22: Injections of Anatomical Regions and Diseases: Shoulder
		22.1	 Sternoclavicular Joint
			22.1.1	 Anatomy and Biomechanics
			22.1.2	 Pathologies and Indication for Injections
			22.1.3	 Appliances
			22.1.4	 Agents
			22.1.5	 Injection Technique
			22.1.6	 Aftercare
		22.2	 Acromioclavicular Joint
			22.2.1	 Anatomy and Biomechanics
			22.2.2	 Pathologies and Indication for Injections
			22.2.3	 Appliances
			22.2.4	 Agents
			22.2.5	 Injection Technique
			22.2.6	 Aftercare
		22.3	 Subacromial Bursa
			22.3.1	 Anatomy and Biomechanics
			22.3.2	 Pathologies and Indication for Injections
			22.3.3	 Appliances
			22.3.4	 Agents
			22.3.5	 Injection Technique
			22.3.6	 Aftercare
		22.4	 Glenohumeral Joint
			22.4.1	 Anatomy and Biomechanics
			22.4.2	 Pathologies and Indication for Injections
			22.4.3	 Appliances
			22.4.4	 Agents
			22.4.5	 Injection Technique
			22.4.6	 Aftercare
		References
	23: Injections of Anatomical Regions and Diseases: Elbow
		23.1	 Elbow
			23.1.1	 Anatomy, Diagnosis, and Indications
			23.1.2	 Type of Injections and Agents
			23.1.3	 Technique/Tricks/Pitfalls
			23.1.4	 Aftercare
		23.2	 Radial Tuberosity (Biceps Tendon Insertion)
			23.2.1	 Anatomy, Diagnosis, and Indications
			23.2.2	 Technique/Tricks/Pitfalls
			23.2.3	 Type of Injections and Agents
			23.2.4	 Aftercare
		23.3	 Lateral Epicondylitis
			23.3.1	 Anatomy, Diagnosis, Indications, and Type of Injection Agents
			23.3.2	 Technique/Tricks/Pitfalls
			23.3.3	 Aftercare
		23.4	 Medial Epicondylitis
			23.4.1	 Anatomy, Diagnosis, Indications, and Type of Injection Agents
			23.4.2	 Technique/Tricks/Pitfalls
			23.4.3	 Aftercare
		23.5	 Olecranon Bursitis
			23.5.1	 Anatomy, Diagnosis, Indications, and Type of Injection Agents
			23.5.2	 Technique/Tricks/Pitfalls
			23.5.3	 Aftercare
		23.6	 Conclusions
		References
	24: Injections of Anatomical Regions and Diseases: Wrist and Hand
		24.1	 Wrist Joint
			24.1.1	 Anatomy
			24.1.2	 Indication and Diagnosis
			24.1.3	 Appliances
			24.1.4	 Agents
			24.1.5	 Technique/Tricks/Pitfalls
			24.1.6	 Aftercare
		24.2	 Distal Radioulnar Joint
			24.2.1	 Anatomy
			24.2.2	 Indication and Diagnosis
			24.2.3	 Appliances
			24.2.4	 Agents
			24.2.5	 Technique/Tricks/Pitfalls
			24.2.6	 Aftercare
		24.3	 Trapeziometacarpal Joint (Carpometacarpal Joint of the Thumb)
			24.3.1	 Anatomy
			24.3.2	 Indication and Diagnosis
			24.3.3	 Appliances
			24.3.4	 Agents
			24.3.5	 Technique/Tricks/Pitfalls
			24.3.6	 Aftercare
		24.4	 Metacarpophalangeal and Interphalangeal Joints
			24.4.1	 Anatomy
			24.4.2	 Indication and Diagnosis
			24.4.3	 Appliances
			24.4.4	 Agents
			24.4.5	 Technique/Tricks/Pitfalls
			24.4.6	 Aftercare
		24.5	 Ganglion Cyst
			24.5.1	 Anatomy
			24.5.2	 Indication and Diagnosis
			24.5.3	 Appliances
			24.5.4	 Agents
			24.5.5	 Technique/Tricks/Pitfalls
			24.5.6	 Aftercare
		24.6	 De Quervain’s Tenosynovitis
			24.6.1	 Anatomy
			24.6.2	 Indication and Diagnosis
			24.6.3	 Appliances
			24.6.4	 Agents
			24.6.5	 Technique/Tricks/Pitfalls
			24.6.6	 Aftercare
		24.7	 Carpal Tunnel Syndrome
			24.7.1	 Anatomy
			24.7.2	 Indication and Diagnosis
			24.7.3	 Appliances
			24.7.4	 Agents
			24.7.5	 Technique/Tricks/Pitfalls
			24.7.6	 Aftercare
		24.8	 Trigger Finger (Stenosing Tenosynovitis)
			24.8.1	 Anatomy
			24.8.2	 Indication and Diagnosis
			24.8.3	 Appliances
			24.8.4	 Agents
			24.8.5	 Technique/Tricks/Pitfalls
			24.8.6	 Aftercare
		References
	25: Injections of Anatomical Regions and Diseases: Hip
		25.1	 Hip Joint
			25.1.1	 Procedure
		25.2	 Trochanteric Bursitis
			25.2.1	 Procedure
		25.3	 Osteitis Pubis
			25.3.1	 Procedure
		25.4	 Iliopsoas Bursitis
			25.4.1	 Procedure
		25.5	 Hamstring Origin and Ischial Bursitis
			25.5.1	 Procedure
		25.6	 Deep Gluteal Space
			25.6.1	 Procedure
		References
	26: Injections of Anatomical Regions and Diseases: Knee
		26.1	 Knee Joint
			26.1.1	 Anatomy
			26.1.2	 Indication and Diagnosis
			26.1.3	 Appliances
			26.1.4	 Agents
			26.1.5	 Technique/Tricks/Pitfalls
			26.1.6	 Aftercare
		26.2	 Pes Anserine Bursa
			26.2.1	 Anatomy
			26.2.2	 Indication and Diagnosis
			26.2.3	 Appliances
			26.2.4	 Agents
			26.2.5	 Technique/Tricks/Pitfalls
			26.2.6	 Aftercare
		26.3	 Prepatellar Bursa
			26.3.1	 Anatomy
			26.3.2	 Indication and Diagnosis
			26.3.3	 Appliances
			26.3.4	 Agents
			26.3.5	 Technique/Tricks/Pitfalls
			26.3.6	 Aftercare
		26.4	 Iliotibial Band
			26.4.1	 Anatomy
			26.4.2	 Indication and Diagnosis
			26.4.3	 Appliances
			26.4.4	 Agents
			26.4.5	 Technique/Tricks/Pitfalls
			26.4.6	 Aftercare
		References
	27: Injections of Anatomical Regions and Diseases: Ankle and Foot
		27.1	 Ankle Joint
			27.1.1	 Anatomy and Biomechanics
			27.1.2	 Pathologies and Indications for Injections
			27.1.3	 Appliances
			27.1.4	 Agents
			27.1.5	 Injection Technique
			27.1.6	 Aftercare
		27.2	 Achilles Tendon Pathologies
			27.2.1	 Anatomy and Biomechanics
			27.2.2	 Pathologies and Indications for Injections
			27.2.3	 Appliances
			27.2.4	 Agents
			27.2.5	 Injection Technique
			27.2.6	 Aftercare
		27.3	 Plantar Fasciopathy
			27.3.1	 Anatomy and Biomechanics
			27.3.2	 Pathologies and Indications for Injections
			27.3.3	 Appliances
			27.3.4	 Agents
			27.3.5	 Injection Technique
				27.3.5.1	 Supine Technique
				27.3.5.2	 Prone Technique
			27.3.6	 Aftercare
		27.4	 Morton’s Neuroma
			27.4.1	 Anatomy and Biomechanics
			27.4.2	 Pathologies and Indications for Injections
			27.4.3	 Appliances
			27.4.4	 Agents
			27.4.5	 Injection Technique
			27.4.6	 Aftercare
		27.5	 Toe Joint: Sesamoids
			27.5.1	 Anatomy and Biomechanics
			27.5.2	 Pathologies and Indications for Injections
			27.5.3	 Appliances
			27.5.4	 Agents
			27.5.5	 Injection Technique
				27.5.5.1	 MTP Joint Injection
				27.5.5.2	 Sesamoid Injection
			27.5.6	 Aftercare
		References