III. Contraindications

  1. Significant Tendon Injury or partial rupture
  2. Recent or multiple injections at the same site
    1. Avoid repeat injection within 3-4 months
  3. Infection (overlying Cellulitis, bacteremia)
  4. Uncontrolled Diabetes Mellitus
  5. Coagulopathy

IV. Adverse Effects

  1. Specific adverse effects
    1. Tendon rupture or atrophy
    2. Fistula formation from the tendon sheath
      1. Z-Tracking needle (redirecting needle when within subcutaneous fat) reduces fistula risk
  2. General injection related adverse effects
    1. Local infection
    2. Bleeding
    3. Systemic effects of Corticosteroids (e.g. Hyperglycemia)
    4. LAST Reaction (e.g. intravascular injection of Anesthetic)

V. Technique

  1. See regional indications above for specific tendon approaches
  2. Informed Consent
  3. Identify landmarks (anatomy, Ultrasound) and mark injection site
  4. Prepare injection site (e.g. Chlorhexidine, Povidone Iodine)
  5. Insert needle (consider z-tracking), advancing slowing and stopping if Paresthesia
  6. Aspirate for intravascular location
  7. Inject slowly at insertion site

VI. References

  1. Warrington (2023) Crit Dec Emerg Med 37(1): 14-5

Images: Related links to external sites (from Bing)

Related Studies