Complications of Intraarticular Joint Injections and Musculoskeletal Injections

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Chapter 18 Complications of Intraarticular Joint Injections and Musculoskeletal Injections

Eric G. Cornidez

Chapter Overview

Chapter Synopsis: Intraarticular joint and musculoskeletal injections are considered among the least invasive interventional therapies for chronic pain; nevertheless, the procedures carry inherent risks. Complications associated with intraarticular injection can arise from needle misplacement, causing bleeding, infection, or nerve injury, or from interactions with the injectate itself. Injected air can result in air embolism, and hyaluronic acid injection can produce synovitis. The risks of trigger point injection are usually limited to pain at the injection site, but infection and damage to surrounding structures can uncommonly arise.

Important Points:

image There should be a constant awareness of potential complications from interventional pain procedures, and efforts to minimize these complications should be implemented.
image Although uncommon, complications from intraarticular injections arise from needle placement or the injectate itself.
image Trigger points are arguably considered among the safest interventions in a pain practice; however, they are not without risk. This risk includes tenderness at injection site, bleeding, infection, and injury to nearby structures.

Introduction

Over recent years, interventional pain management has grown steadily. Consequently, the prevention of complications from interventional pain procedures should be a very important aspect of pain management. Although the true incidence is difficult to assess, it is extremely important to note and understand the potential risks and consequences. Appendicular intraarticular joint (hip, knee, shoulder, hand) and musculoskeletal injections are deemed some of the safest procedures performed in interventional pain management. The most common complications are infection, although septic arthritis, osteomyelitis, peripheral nerve injuries, pneumothorax, and skeletal muscle toxicity have all been reported (Table 18-1). The use of ultrasonography or fluoroscopy can assist in the visualization of nearby structures, thus decreasing the incidence of damage of these structures.

Table 18-1 Potential Complications and Avoidance at Each Site

Joint Problem Avoidance
Hip joint
Infection
Neurovascular (femoral) injury
Air embolism
Synovitis

Meticulous sterile technique
Ultrasonography for visualization
Minimal air for injectate
Reasonable concentration of corticosteroid
Shoulder joint
Infection
Neurovascular (axillary or brachial plexus) injury
Meticulous sterile technique
Ultrasonography
Knee joint
Infection
Neurovascular injury
Meticulous sterile technique
Ultrasonography
Intramuscular or trigger point
Bleeding
Infection
Myositis
Injury to nearby structures
Use smaller gauge needle
Meticulous sterile technique
Avoid myotoxic local anesthetic (i.e., bupivacaine)
Ultrasonography for visualization

Hip Joint Injections

Hip injection is a common procedure to alleviate hip pain because this is a location commonly affected by osteoarthritis (Fig. 18-1

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