Injection

Click here for Aspiration and Injection CPT Codes

Shoulder Corticosteroid Injections:

  • AAOS orthoguidelines cannot recommend for or against subacromial injections for patients with rotator cuff tears.
  • Corticosteriod injections significantly weaken Rat RTC tendons at one week which retuns to normal by 3 weeks (Mikolyzk DK, JBJS 2009;91:1172).
  • Lidocaine causes cytotoxicity to tenocytes, decreased biomechanical properties, and induced apoptosis and delay of collagen organization in rotator cuff tendons. (Honda H, J Orthop Res 34:1620–1627, 2016).  (Nakamura H, J Orthop Res 33:1523–1530, 2015).

Ankle Corticosteroid Injection

  • Adverse event rate following intra-articular ankle or subtalar joint corticosteroid injection is 5.8%.  Postinjection flare is the most common complication. (Anderson S, Foot & Ankle International®
    2019, Vol. 40(6) 622–628)

Example injection dictation

PROCEDURE:  steroid injection. 

PREOPERATIVE DIAGNOSIS:

 

POSTOPERATIVE DIAGNOSIS: same.

 

PROCEDURE: The patient was apprised of the risks and the benefits of the procedure and consented. The  heel was sterilely prepped with Betadine. A 1 mg of dexamethasone was drawn up into a 5 mL syringe with a 1 mL of 1% lidocaine and 1ml of marcaine. The patient was injected with a 1.5-inch 25-gauze needle. There were no complications. The patient tolerated the procedure well. There was minimal bleeding. The patient will avoid overuse over the next few days. The patient was instructed to go to follow up with us if any unusual pain, swelling, or redness occurs in the injected area. The patient was given a followup appointment to evaluate response to the injection

 

 

References

  • AAOS Orthoguidelines
  • Adebajo AO, Nash P, Hazleman BL. A prospective double blind dummy placebo controlled study comparing triamcinolone hexacetonide injection with oral diclofenac 50 mg TDS in patients with rotator cuff tendinitis. J Rheumatol 1990;17(9):1207-1210.
  •  Alvarez CM, Litchfield R, Jackowski D, Griffin S, Kirkley A. A prospective, double-blind, randomized clinical trial comparing subacromial injection of betamethasone and xylocaine to xylocaine alone in chronic rotator cuff tendinosis. Am J Sports Med 2005;33(2):255-262.
  • Withrington RH, Girgis FL, Seifert MH. A placebo-controlled trial of steroid injections in the treatment of supraspinatus tendonitis. Scand J Rheumatol 1985;14(1):76-78.
  • Blair B, Rokito AS, Cuomo F, Jarolem K, Zuckerman JD. Efficacy of injections of corticosteroids for subacromial impingement syndrome. J Bone Joint Surg Am 1996;78(11):1685-1689.
  • Vecchio PC, Hazleman BL, King RH. A double-blind trial comparing subacromial methylprednisolone and lignocaine in acute rotator cuff tendinitis. Br J Rheumatol 1993;32(8):743-745.
  • Akgun K, Birtane M, Akarirmak U. Is local subacromial corticosteroid injection beneficial in subacromial impingement syndrome? Clin Rheumatol 2004;23(6):496-500.