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Home , Olecranon bursitis, Retrocalcaneal bursitis

Index

A tarsal tunnel syndrome, 374 Achilles , 43–44 tibiotalar joint injection, 387–390 Achilles tendon peritendinous injection Ankle sprain, 373 contraindications and indications, 383 Autologous blood injections, 206 procedure, 385–386 side effects, 383 technique, 383–385 B templates, 405 Bicipital tendonitis, 41 Acromioclavicular (AC) joint injection Bicipital tendon sheath injection contraindications and indications, 151 bicipital tendonitis, 142–143 corticosteroid injection, 139 contraindications and indications, 156 fluoroscopic guidance, 152 coracobrachialis muscle, 143 image guidance, 138 procedure, 156, 158 procedure, 153–154 side effects, 156 side effects, 151 technical details, 156, 157 technical details, 151–153 ultrasound, 157 Aka finger flexor tendon sheath injection. See Billing and coding current procedural terminology (CPT), 120 Aka golfer’s . See Medial epicondylitis examples, 121–122 (ME) ICD–9 code, 120 Aka . See Lateral epicondylitis (LE) internet, 121 Ankle and foot region injection modifier codes achilles tendon peritendinous injection, modifier 25, 123–124 383–386 modifier 53, 128 image guidance, 371 modifier 50, bilateral procedure, 124 morton neuroma, 374 modifier 51 vs. modifier 59, 124–127 MTP joint injection, 372, 392–394, 406 , olecranon. See pigmented villonodular (PVNS), 372 injection, 396–399, 407 C plantar , 373 Capitellum, 206 procedure, 375–376 Carpal tunnel injection (CTI) retrocalcaneal bursa/achilles bursa, effectiveness of, 229, 231 380–382, 404 median nerve injury, 229 , 374 procedure for sesamoid bone, 373 step-by-step, 236 sinus tarsi syndrome, 374 technical details, 234–235 subtalar joint, 373 side effects, 234 subtalar joint injection, 400–403, 408 templates, 257

T.P. Stitik (ed.), Injection Procedures: Osteoarthritis and Related Conditions, 437 DOI 10.1007/978-0-387-76595-2, © Springer Science+Business Media, LLC 2011 438 Index

Carpal tunnel syndrome (CTS), 42, 229, 231 aspiration/injection Chondroprotection, 79 step-by-step procedure, 221, 223 CMC. See First carpometacarpal joint technical details, 221, 222 Cochrane meta-analysis, 71 templates, 228 Corticosteroids injection procedures, 204 classification, 36 joint , 206 contraindications, 52–53 lateral epicondylitis dexamethasone, 37 corticosteroid injection, 205 injection definition, 203 joint and , 27 injection procedure, 209–211 for lateral epicondylitis, 205 recalcitrant or chronic, 205 for medial epicondylitis, 205–206 medial epicondylitis olecranon bursitis, 206 corticosteroid injections, 205–206 for Quervain’s , 231 injection procedure, 212–214 trigger finger, 263 olecranon bursitis mechanisms, 34–35 aspiration/injection, 215–217 methylprednisolone, 37 corticosteroid injection, 206 musculoskeletal disorders, 40–41 radiocapitellar injection, 28, 218–220, 227 OA patients, 40 Electromyography (EMG) osteoarthritis, efficacy, 38–40 lateral femoral cutaneous nerve block, side effects, 44–52 314, 316 triamcinolone, 37 office-based injection procedure CTI. See Carpal tunnel injection administration, 105 suprascapular nerve block, 187 Epidural steroid injection, low back pain, D 94–96 de Quervain’s tenosynovitis injection clinical diagnosis, 238 corticosteroid injections, 42–43, 231 F procedure, 238, 240 Facet syndrome, 96–97 technical details, 238, 239 First carpometacarpal (CMC) joint templates, 258 injection procedure Digital nerve block contrast injection, 271 applications, 265 step-by-step, 268, 270–271 injection procedure technical details, 268, 269 contraindications and side effects, 285 templates, 289 step-by-step, 287–288 Fluoroscopy technical details, 285–287 achilles bursa injection, 381 templates, 293 acromioclavicular (AC) joint, 151–154 Discography, sacroiliac joint pain, 98 ankle joint injection, 388 Distal radial ulnar joint (DRUJ) ankle subtalar joint injection, 401 injection procedure carpometacarpal (CMC) joint injection, 269 identification and marking of injection elbow joint injection, 222 site, 244 glenohumeral joint, 137, 160, 165 image guidance, 242, 244 hip joint injection, 307 needle placement, 244 iliopsoas bursa injection, 303 technical details, 242, 243 intra-articular parapatellar knee joint templates, 259 injection, 340 isolated injection, 231 intra-articular retropatellar knee joint, 339 DRUJ. See Distal radial ulnar joint intra-articular suprapatellar bursa, 339 ischial bursa injection, 312 joint and soft tissue injection, 10, 28 E lateral epicondylar region injection, 210 Elbow-joint lateral femoral cutaneous nerve block, 315 arthropathy, 206 low back pain, 94 Index 439

medial epicondylar region injection, 213 iliopsoas bursa injection, 302–304, 322 metacarpophalangeal (MCP) joint intra-articular hip injection, 306–309, 323 injection, 273 ischial bursa, 300 metatarsophalangeal (MTP) joint injection, ischial bursa injection, 311–313, 324 393 ischial tuberosity bursa, 300 radiocapitellar joint injection, 219 lateral femoral cutaneous nerve block, subacromial bursa injection, 177 314–318, 325 subacromial space, 137 meralgia paresthetica, 300 suprascapular nerve block, 185 trochanteric bursa injection, 318–321, 326 tibiofibular joint injection, 364 ultrasound guided, 299 trochanteric bursa injection, 319 viscosupplementation, 299 weaver’s bursitis, 300 Hyaluronic acid (HA) G binding, 70 efficacy, 71 injection procedure, 246, 248 viscosupplementation, disease technical details, 246, 247 modification, 81–82 templates, 260 vs steroid, 74 treatment, 231 Glenohumeral joint capsule distension arthrography injection I contraindications and indications, 159 Iliopsoas bursa injection fluoroscopy, 165 contraindications and indications, 302 procedure, 159, 161–162 procedure, 302, 304 side effects, 159 side effects, 302 technical details, 159, 160 technical details, 302, 303 Glenohumeral joint injection templates, 322 adhesive capsulitis, 139 Iliotibial band injection contraindications and indications, 164 contraindications and indications, 335 fluoroscopy, 160 procedure, 335, 337 osteoarthritis, 139 side effects, 335 procedure, 164, 166–167 technical details, 335, 336 side effects, 164 templates, 366 technical details, 164, 165 Intra-articular hip injection viscosupplementation, 140 contraindications and indications, 306 procedure, 308–309 side effects, 306 H technical details, 306–308 HA. See Hyaluronic acid (HA) templates, 323 Hand Intra-articular knee aspiration corticosteroid injection, 263 contraindications and indications, 338 digital nerve blocks, 265 injection procedure injection procedure image guidance, 343 digital nerve block, 285–288 local anesthesia, 345 first carpometacarpal (CMC) joint, needle placement, 345–346 268–271 patient positioning, 343–344 MCP/IP joint, 272–275 postprocedural testing, 347 subungual hematoma drainage, site identification, 344–345 277–279 skin preparation, 345 trigger finger, 281–284 side effects, 338 metacarpophalangngeal joints, 265 technical details osteoarthritis, 263, 265 corticosteroid preparation, 338 subungual hematoma, 266 mini-air arthrography, 343 Hip region injection needle gauge, 338 fluoroscopic guided, 299 parapatellar approach, 340–341, 343 440 Index

Intra-articular knee aspiration (cont.) disadvantages of, 19–20 retropatellar approach, 339, 341, 342 vapocoolant spray, 20 suprapatellar bursa approach, lumbar spinal stenosis, 27 338–342 material preparation templates, 366 injection chart, 15 Intra-articular knee viscosupplementation medication selection, 17–18 contraindications and indications, 348 multidose bottles, 16–17 procedure, 348–349 needle selection, 15, 16 side effects, 348 non-sterile gloves, 15 technical details, 348 syringe selection, 16 templates, 367 patient anxiety, 27–28 Ischial bursa injection patient positioning, 12–13 contraindications and indications, 311 pharmacotherapy procedure, 311, 313 corticosteroids, 36–53 side effects, 311 local anesthetics, 53–55 technical details, 311, 312 omnipaque™ templates, 324 vs. ionic contrast agents, 56–57 pharmacokinetics, 57 side effects, 57–58 J post-procedure phase, 26 Joint and soft tissue injection spinal needle, 16 anatomic model, 28 synovial fluid, classification, 6 antiseptic agents properties, 14 therapeutic uses aspiration corticosteroid injection, 7 laboratory analysis, 23 fluid aspiration, 7 needle trajectory, 22 viscosupplementation, 7–8 bursal/synovial fluid analysis, 6–7 ultrasound, 3 bursitis, 27 vasovagal reaction, 29 care, post-procedure, 20–22 contraindications, 8 corticosteroid injection, 27 K diagnostic uses Knee joint lavage palpatory pain, 6 contraindications and indications, 350 rotator cuff weakness, 4 procedure, 350, 352–353 subacromial, pain, 4 side effects, 350 VAS pain, 5 technical details, 350, 351 documentation, 27 Knee region injection fluoroscopic-guidance, 28 accuracy, 330–331 informed consent cadaver instruction, 332 allergic reaction, 10 hyalgan, 331 ester-type anesthetics, 9–10 iliotibial band injection, 335–337, 366 novocaine, 10 intra-articular knee aspiration and povidone-iodine skin antiseptics, 11 corticosteroid injection, 338–347, pseudoseptic reaction, 11–12 366 subcutaneous fat atrophy, 12 intra-articular knee viscosupplementation, injection 348–347, 367 fluoroscopic-guidance, 25 knee joint lavage, 350–353 needle and syringe, unclamping and pes anserine injection, 354–356 clamping, 23–25 popliteal/baker cyst injections, 357–359, 368 peritendinous injection, 24–25 injection, 360–362, 369 technique, 23–25 procedure, 327–330 injection site marking and cleansing, 13 tibiofibular joint injection, 363–365, 370 local anesthetic administration ultrasound guidance, 331 advantages of, 18 viscosupplementation, 331 Index 441

L injection Lateral epicondylitis (LE) contraindications and indications, 392 corticosteroid injection, 205 procedure, 392. 394 definition, 203 side effects, 392 injection procedure, 209, 211 technique, 392, 393 pharmacotherapy, 41 templates, 406 recalcitrant or chronic, 3 osteoarthritis, 372 technical details, 201, 209 Morton neuroma, 374 templates, 224 Musculoskeletal disorders Lateral femoral cutaneous nerve block achilles tendinopathy, 43–44 injection bicipital tendonitis, 41 contraindications and indications, 314 carpal tunnel syndrome (CTS), 42 injection procedure, 314, 316–318 deQuervain’s tenosynovitis, 42–43 side effects, 314 lateral epicondylitis, 41 technical details, 314, 315 medial epicondylitis, 42 templates, 325 , 44 LE. See Lateral epicondylitis trigger finger, 43 Lidocaine, 10 trochanteric bursitis, 43 Low back pain differential diagnosis, 93 epidemiology, 92 N epidural steroid injection Needle trephination, 266, 277–279 anesthetic injection, 96 bupivacaine infiltration, 95 saline injection, 95 O spinal stenosis, 96 OA. See Osteoarthritis (OA) facet syndrome Office-based injection procedure chronic spine pain, 96 administration diagnosis, 97 billing and coding SPECT, 97 current procedural terminology (CPT), initial treatment 120 interventional spine procedure, 94 examples, 121–122 physical examination, 94 ICD–9 code, 120 red flags, 93–94 modifier codes, 123–127 sacroiliac joint pain, discography, 98 Pub Med, 121 diagnostic tests caution, 106 M electrodiagnostics, 105–106 Marcaine, 17–18 EMG, 105–106 MCP/IP. See Metacarpophalangngeal/ financial viability, 105 interphalangeal joints financial viability, 105 Medial epicondylitis (ME) injection financial viability effect corticosteroid injections, 205–206 competitive acquisition program injection procedure, 212, 214 (CAP), 107 pharmacotherapy, 42 investment, materials, 107 technical details, 212, 213 J-code reimbursement, 108 templates, 225 pharmacy arrangement, 107 Metacarpophalangngeal/interphalangeal HCFA 1500 claim form, 127 (MCP/IP) joints implementation injection procedure, 272, 275 block scheduling, 115–116 technical details, 272–274 informed consent form, 117–118 templates, 290 insurance authorization, 115 Metatarsophalangeal (MTP) joint patient medical record, 119 gouty crystals, 372 pre-certification, 115 442 Index

Office-based injection procedure procedure, 354, 356 administration (cont.) side effects, 354 medicare role technical details, 354, 355 current procedural terminology (CPT) Plantar fascia injection code, 102 contraindications and indications, 396 document failure, 102 procedure, 398–399 health care attorney, 104 side effects, 396 patient record auditing, 103–104 technique, 396–398 policy changes, 101 templates, 407 treble damages, 102 Plantar fasciitis, 44, 373 viscosupplementation Popliteal/baker cyst injections claims support and appeal process, 113 contraindications and indications, 357 HCPCS and CPT codes, 112–113 procedure, 357, 359 ICD–9-CM diagnosis codes, 112 side effects, 357 medicaid, 110–111 technical details, 357, 358 payer coverage and reimbursement, templates, 368 medicare, 108–110 Prepatellar bursa injection private insurance, 111 contraindications and indications, 360 reimbursement hotlines, 113, 115 procedure, 360, 362 Olecranon bursitis side effects, 360 aspiration/injection technical details, 360, 361 procedure, 215, 217 templates, 369 side effects, 215 technical details, 215, 216 templates, 226 R corticosteroid injection, 206 Radiocapitellar articulation, 206 Omnipaque™ Radiocapitellar injection, elbow, 218–220, 227 AC joint injection, 153–154 Radiofrequency ablation (RFA), 97 CMC, 271 Radiosynoviorthesis, 265 glenohumeral joint capsule distension Red flags, low back pain, 93–94 arthrography, 162 Retrocalcaneal bursa/achilles bursa vs. ionic contrast agents, 56–57 contraindications and indications, 380 pharmacokinetics, 57 procedure, 380, 382 side effects, 57–58 side effects, 380 subacromial injection, 178 technique, 380, 381 subtalar joint injection, 402 templates, 404 suprascapular nerve block, 188 Retrocalcaneal bursitis, 374 TFCC, 251 Rotator cuff tendon injection tibiotalar joint, 390 infraspinatus Osteoarthritis (OA) contraindications and indications, 168 disease modification, 81 procedure, 168, 170 hand, 263, 265 side effects, 168 joint and soft tissue injection, technical details, 168, 169 pharmacotherapy ultrasound, 169 efficacy, 38–40 subacromial injection, 140 patients, 40 subscapularis knee, 77 contraindications and indications, 181 treatment, 72 procedure, 181, 183 side effects, 181 technical details, 181, 182 P ultrasound, 182 Panner’s disease, 206 supraspinatus Pes anserine injection contraindications and indications, 184 contraindications and indications, 354 procedure, 186–188 Index 443

side effects, 184 Tibiotalar joint injection technical details, 184–186 contraindications and indications, 387 ultrasound, 190 procedure, 389–390 teres minor, 142 side effects, 387 technique, 387–389 Trephination, needle, 266, 277–279 S Triangular fibrocartilage complex (TFCC) Sacroiliac joint pain, discography, 98 injection Severe acute inflammatory reaction (SAIR) needle placement, 251 pseudogout reaction, and a septic knee, 78 procedure, 249, 251–252 viscosupplementation, side effects, 77–78 technical details, 249, 250 Single photon emission computed tomography templates, 261 (SPECT), 97 Trigger finger injection, 43 Sinus tarsi syndrome, 374 corticosteroids for, 263 Spinal stenosis, 96 injection procedure, 281, 283–284 Sternoclavicular (SC) joint injection technical details, 281, 282 contraindications and indications, 171 templates, 292 procedure, 171, 173 Trochanteric bursa injection side effects, 171 contraindications and indications, 318 technical details, 171, 172 procedure, 318, 320–321 Subacromial bursa injection side effects, 318 contraindications and indications, 174 technical details, 318, 319 fluoroscopy, 177 templates, 326 procedure, 174, 176, 178–180 Trochanteric bursitis, 43 side effects, 174 subacromial, diagnostic, 138 technical details, 174–177 U ultrasound, 175 Ultrasound Subtalar joint injection achilles tendon sheath injection, 384 contraindications and indications, 400 bicipital tendon sheath injection, 157 procedure, 402–403 carpal tunnel injection, 235 side effects, 400 de Quervain’s disease, 239 technique, 400–402 distal radioulnar joint injection, 243 templates, 408 infraspinatus tendon injection, 169 Subungual hematoma injection interphalangeal (IP) joint injection, 274 contraindications and side effects, 277 olecranon bursa aspiration/injection, 216 injection procedure pes anserine bursa injection, 355 procedure, 277, 279 plantar fascia injection, ankle, 397 technical details, 277, 278 popliteal cyst aspiration, 358 templates, 291 sternoclavicular (SC) joint injection, 172 trephination, 266, 278 subacromial bursa injection, 175 Suprascapular nerve block, 143–145 subscapularis tendon injection, 182 Suprascapular nerve block injection supraspinatus tendon injection, 190 contraindications and indications, 189 TFCC injection, 250 fluoroscopy, 185 trigger finger injection, 282 procedure, 189, 191 wrist joint injection, 254 side effects, 189 Upper limb/shoulder region injection technical details, 189, 190 acromioclavicular (AC) joint, 138–139, 151–155 anatomic considerations, 136 T bicipital tendon sheath, 142–143, Tarsal tunnel syndrome, 374 156–158 TFCC. See Triangular fibrocartilage complex diagnosis, 133 injection glenohumeral joint, 139–140, 164–167 444 Index

Upper limb/shoulder region injection (cont.) ICD–9-CM diagnosis codes, 112 glenohumeral joint capsule distension joint and soft tissue injection, 7–8 arthrography, 159–162 mechanism imaging, 136 biological effects, 68, 70 physical examination, 135–136 HA binding, 70 procedure, 134 hyaluronan loss, 68 rotator cuff tendon synovial fluid, 67 infraspinatus, 141, 168–170 viscoelastic properties, 68 subacromial injection, 140 payer coverage and reimbursement subscapularis, 142, 181–183 medicaid, 110–111 supraspinatus, 141–142, 184–188 medicare, 108–110 teres minor, 142 private insurance, 111 sternoclavicular (SC) joint, 145–146, prognostic factors, 76–77 171–173 reimbursement hotlines, 113, 115 subacromial bursa, 137–138, 174–180 SAIR, 78 suprascapular nerve block, 143–145 side effects, 77 Visual analogue scale (VAS), 4

V Viscosupplementation W claims support and appeal process, 113 Weaver’s bursitis, 300 disease modification Wrist cartilage matrix, 80–81 carpal tunnel injection, 229, 231 cartilage repair and healing, 79–80 corticosteroid injections, 231 chondroprotection, 79 ganglion cysts, 231 HAs, 81–82 injection procedure OA animal models, 81 carpal tunnel injection, 234–236 efficacy de Quervain’s Tenosynovitis, 238–240 Cochrane meta-analysis, 71 distal radio-ulnar joint, 242–245 HAs, 73 ganglion cyst aspiration/injection, HA vs. steroid, 74 246–248 hylauronate, 70 intercarpal approach, wrist joint knee lavage, HAs, 75–76 injection, 253–255 knee mechanics, HAs, 75 triangular fibrocartilage complex muscle strength, HAs, 74–75 injection, 249–252 therapeutic exercise, 73–74 Wrist joint injection, intercarpal approach total knee replacement (TKR), 72 step-by-step procedure, 253, 255 FDA approved, 69 technical details, 253, 254 HCPCS and CPT codes, 112–113 templates, 262 hip region injection, 299 ultrasound, 254