How are patients with joint and soft tissue injuries evaluated prior to treatment with corticosteroid injection?

Updated: Mar 01, 2019
  • Author: Jess D Salinas, Jr, MD; Chief Editor: Elizabeth A Moberg-Wolff, MD  more...
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Answer

Answer

As with the treatment of any disorder, a carefully taken patient history and a carefully made physical examination are of paramount importance. Sharp, severe, intense pain suggests the presence of a more acute, traumatic reaction with marked inflammation. Dull, low-grade, chronic pain indicates the existence of a mild inflammatory reaction, a chronic overuse injury, or arthritis. Radiation of pain or additional neurologic symptoms (eg, tingling, burning, numbness) imply additional neurologic involvement. Medication history is important because discontinuation of anti-inflammatory medications often precipitates a reaction. Dietary changes also may precipitate reactions, such as an attack of gout.

The physical examination is performed to assess the location and severity of the reaction. Determination of whether the inflammation is in the muscle, tendon, or joint is of paramount importance. Trigger points in muscles can be easily identified if the clinician uses the appropriate palpation skills. Many clinicians ask their patients to identify the site of greatest discomfort. Patients often know exactly where the source of their pain is, having spent hours localizing it.

Radiographic studies may or may not be beneficial, because it takes a significant amount of effusion for the injury to appear on a routine radiograph. Usually, clinical symptoms are present and treatable long before a radiographic abnormality may be identified. On the other hand, radiographs are important in evaluating for fracture or determining acuity.

If joint and cartilage damage exists, the clinician knows that a long-standing process is involved. Electromyograms (EMGs) are extremely beneficial in determining whether there is a significant neurologic component to the patient's symptoms. This determination is important in targeting injection sites. Blood work can include blood counts and chemistry series. An elevated leukocyte or white blood cell count may indicate infection. An elevated erythrocyte sedimentation rate suggests that a significant myopathic or arthritic process has developed. Elevated rheumatoid factor implies chronic arthritic conditions, such as rheumatoid arthritis. Elevated uric acid levels are sometimes observed in patients with gout.


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