Session Type: ACR/ARHP Combined Abstract Session
Session Time: 9:00AM-11:00AM
Background/Purpose: Ultrasound (US)-guided injections in musculoskeletal medicine typically utilize either local puncture site sterility or conventional surgical sterility. We report on the safety and complications of US-guided injections using local puncture site sterility.
Methods: Local puncture site sterility requires an initial cleansing of the injection site with chlorhexidine antiseptic. The clean, non-sterile US-gel is then placed on the clean, non-sterile US-probe and then both on the skin. Contamination is avoided through use of a longer needle that allows increased distance between the needle puncture site and US-gel-probe (Figure 1A). Under IRB approval, we analyzed 1115 consecutive US-guided corticosteroid injections (in 81.5% females and 18.5% males) to treat predominantly localized osteoarthritis and rheumatoid arthritis. Patient outcomes at 1, 3, 6 and 12 months post-procedure were reviewed for procedural-related complications.
Results: The 1115 US-guided injection procedures consisted of 390 knees (35%), 187 shoulders (17%), 186 carpal tunnels (17%), 120 fingers (interphalangeal and metacarpophalangeal joints, trigger finger) (11%), 47 sacroiliac joints (4.2%), 42 ankles (3.8%), 39 greater trochanteric bursa, (3.5%), 34 wrists (3%), 20 elbows (1.8%), 20 hips (1.8%), 11 popliteal cysts (1%), 11 feet (intertarsal joints) (1%), and 8 toes (interphalangeal and metatarsophalangeal joints (0.7%). Dermal atrophy (Figure 1B) occurred in 51 cases (4.6%), hemorrhage (Figure 2 A) in 1 (0.09%), cellulitis (Figure 2B) in 1 (0.09%), septic joint in 0 (0%), and tendon rupture 0 (0%). All complications resolved with time and proper therapy. The single infection was due to methicillin-sensitive Staphylococcus aureus suggesting endogenous contamination from the patientÕs skin.
Conclusion: US-guided musculoskeletal injections using local puncture site sterility are safe with dermal atrophy being the most common adverse outcome (4.6%). Serious complications, including infection, occur at an incidence less than 0.1% indicating that US-guided injection with local puncture site sterility is an acceptably safe procedural technique.
Figure 1. A. Local puncture site sterility injection. B. Dermal Atrophy after US-guided carpal tunnel injection.
Figure 2. A. Hemarthrosis after US-guided injection. B. Digital cellulitis after US-guided injection.
To cite this abstract in AMA style:Jaradat S, Muruganandam M, Rolle N, Sibbitt W Jr., Hayward W, Emil NS, Fangtham M, Fields R, Bankhurst A. Safety of Ultrasound-Guided Injections Using Local Puncture Site Sterility [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/safety-of-ultrasound-guided-injections-using-local-puncture-site-sterility/. Accessed January 20, 2020.
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