스테로이드 국소 요법 적응증
관절 질환(Joint disease) | 연부 조직 질환(Soft tissue) |
|
|
관절(Joint)
힘줄(Tendons)
인대(Ligaments)
점액낭(Bursae)
신경(Nerve)
|
금기(Contraindications)
절대 금기 | 상대금기 |
|
|
- Patients who taking warfarin, an INR of 3 or less is not a CIx for joint injection.
- For patients on low molecular weight heparins and Direct Oral Anticoagulants (DOACS) no other precautions are necessary.
준비물
needle
musculoskeletal injection에 사용되는 needle sizes
lnjection Site or Disorder | Needle Gauge | Minimum Needle Lengtha(←a 윗첨자) | Typical Total Volume |
Knee | 20-22 G | 1.5 inches (40 mm) | 5-10 mL |
Subacromial bursa | 21-25 G | 1.5-2 inches (40-50 mm) | 5-8 mL |
Glenohumeral joint | 20-22 G | 1.5-2 inches (40-50 mm) | 5-8 mL |
Lateral epicondyle | 22-25 G | 0.5 inch (16 mm) | 1-2 mL |
de Quervain tenosynovitis | 22-25 G | 0.5 inch (16 mm) | 1-2 mL |
Greater trochanteric bursitis | 22-25 G | 1.5-2 inches (40-50 mm) | 4-6 mL |
약물
corticosteroid
[참조] [보충] 주사치료에 사용되는 약제: 스테로이드, 국소마취제 등
국소마취제
[참조] [보충] 주사치료에 사용되는 약제: 스테로이드, 국소마취제 등
주사의 실제
주사 시행 |
|
▼ | |
주사 이후 |
|
스테로이드 국소 요법 합병증
- Most common side effect
- post-injection flare
- facial flushing
- skin or fat atrophy: depends on the compound and dose, route
- Systemic effect: influenced by the agent, dose, frequency, number of joint injected
- Osteoporosis
- Corticosteroid induced myopathy
- suppress HPA axis
- worsening preexisting glucose intolerance
흔히 사용되는 스테로이드 국소요법
Site of Injection | Needle Size | Volume of 1% Lidocaine (mL) | Dose of Triamcinolone (mg) | Common Indication |
Carpal tunnel | 25 G, 1 1/2 " | 0.5-1 | 20 | Carpal tunnel syndrome |
First dorsal compartment | 25 G-27 G, 1 1/2 " | 0.5-1 | 20 | De Quervain tenosynovitis |
Flexor tendon sheath of hand | 25 G, 1 1/2 " | 0.5-1 | 10-20 | Trigger finger |
Subacromial space | 22 G-25 G, 1 1/2 " | 4-5 | 40 | Subacromial bursitis; rotator cuff tendinosis |
Glenohumeral | 22 G-25 G, 3 1/2 " | 4-5 | 40 | Arthritis, adhesive capsulitis |
Acromioclavicular | 25 G, 1 1/2 " | 0.5-1 | 20 | AC degenerative disease ligamentous Irritation |
Trochanteric bursa | 12 G-23 G, 1 1/2 " to 3 1/2 " | 4-5 | 40 | Recalcitrant greater trochanteric pain syndrome |
Iliotibial band | 25 G-27 G, 1 1/2 " | 1-2 | 20 | Recalcitrant distal ITB syndrome |
Hip | 20 G-25 G, 3 1/2 " | 3 | 40 | Arthritis, confirmatim of intraarticular pain source |
Intraarticular knee | 25 G, 1 1/2 " | 3-5 | 40 | Arthritis, aspiration of joint fluid |
Ankle | 25 G, 1 1/2 " | 1-2 | 20-40 | Arthritis, chronic capsulitis |
Morton's neuroma | 25 G-27 G, 1 1/2 " | 0.5-1 | 20 | Perineural fibrosis of interdigital nerve of foot |
참고자료
- Monseau AJ, Nizran PS. Common injections in musculoskeletal medicine. Prim Care 2013;40(4):987–1000, ix–x.
- Rai K, Sylvester J. Musculoskeletal Injections. Current Sports Medicine Reports 2020;19(6):191–3.