Musculoskeletal injection

Abstract

Patients commonly present to primary care physicians with musculoskeletal symptoms. Clinicians certified in internal medicine must be knowledgeable about the diagnosis and management of musculoskeletal diseases, yet they often receive inadequate postgraduate training on this topic. The musculoskeletal problems most frequently encountered in our busy injection practice involve, in decreasing order, the knees, trochanteric bursae, and glenohumeral joints. This article reviews the clinical presentations of these problems. It also discusses musculoskeletal injections for these problems in terms of medications, indications, injection technique, and supporting evidence from the literature. Experience with joint injection and the pharmacological principles described in this article should allow primary care physicians to become comfortable and proficient with musculoskeletal injections.

FIGURE 1.

Anterior view of the right knee showing a medial approach intra-articular injection.

FIGURE 2.

Posterolateral view of the right hip showing the 2 major (subgluteus medius and subgluteus maximus) and 1 minor (subgluteus minimus) trochanteric bursae. Injections should target the bursae that are most painful.

FIGURE 3.

Posterior view of the left shoulder showing the needle directed toward the coracoid process anteriorly. The inset in the upper left corner shows the same joint from an anterior view. Notice the needle placement within the glenohumeral joint.