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1

Moyer, William. Guide to equine joint injection. 2nd ed. Trenton, N. J: Veterinary Learning Systems, 1993.

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2

Moyer, William. A guide to equine joint injection. Princeton, N.J: Solvay Veterinary, 1986.

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3

Anderson, Bruce Carl. House officers guide to arthrocentesis and soft tissue injection. 3rd ed. Portland, Or: JJ & R Medical Publishing, 2001.

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4

Anderson, Bruce Carl. House officers guide to arthrocentesis and soft tissue injection. Portland, OR (8007 SE 140th Dr., Portland, Or. 97236): JJ&R Publishing, 1993.

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5

McNabb, James W. A practical guide to joint & soft tissue injection & aspiration: An illustrated text for primary care providers. 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 2009.

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6

A practical guide to joint & soft tissue injection & aspiration: An illustrated text for primary care providers. 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 2009.

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7

McNabb, James W. A practical guide to joint & soft tissue injection & aspiration: An illustrated text for primary care providers. 2nd ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2010.

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8

McNabb, James W. A practical guide to joint & soft tissue injection & aspiration: An illustrated text for primary care providers. 2nd ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2010.

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9

V, Lawry George, and Fam Adel G, eds. Fam's musculoskeletal examination and joint injection techniques. 2nd ed. Philadelphia: Mosby, 2010.

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10

Jürgen, Fischer. Atlas of injection therapy in pain management. Stuttgart: Thieme, 2012.

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11

Winfield, J. Intra-articular injections using steroid and local anaesthetic. Sheffield: Audio Visual and Television Centre, University of Sheffield, 1988.

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12

V, Lawry George, and Kreder Hans J, eds. Musculoskeletal examination and joint injections techniques. Philadelphia, Pa: Mosby, 2006.

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13

Arden, Nigel, and Terence O’Neill. Intra-articular injection therapy. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199668847.003.0032.

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Intra-articular injection therapy is widely used in the management of osteoarthritis (OA). It has advantages over oral therapy in that it can provide targeted therapy to individual joint sites and at higher dose than could be achieved through oral administration and with fewer adverse effects. Intra-articular steroid therapy, the most widely used intra-articular therapy, is safe and effective in the short term particularly at the knee; though more studies are needed to better characterize the longer-term benefit. The role of intra-articular hyaluronic acid in clinical management of OA is less clear though it may have a role in selected patients in whom other therapies are contraindicated. Currently there are no factors which have been identified as being predictors of response to therapy with intra-articular therapy. Many other intra-articular agents have been used in the management of OA, however, because of the limited evidence base relating to efficacy and safety they cannot currently be recommended for use in routine clinical practice.
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14

Vydyanathan, Amaresh, Karina Gritsenko, Samer N. Narouze, and Allan L. Brook. Cervical Intra-Articular Facet Injection: Computed Tomography. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199908004.003.0009.

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Intra-articular facet joint injections commonly refer to the injection of a contrast media and local anesthetic solution, with or without corticosteroids, directly into the facet joint space. The purpose of this procedure is pain relief as well as to establish an etiological diagnosis for surgical interventions such as joint denervation or radiofrequency ablation. Medial branch block, or facet nerve block, refers to injection of local anesthetic and possible corticosteroids along the medial branch nerve supplying the facet joints. Cervical intra-articular and facet nerve block injections are often part of a work-up for general or focal neck pain, headaches, or cervical muscle spasms. There is limited evidence for short- and long-term pain relief with cervical intra-articular facet joint injections. Cervical medial branch nerve blocks with local anesthetics demonstrate moderate evidence for short- and long-term pain relief with repeat interventions, and strong evidence exists for long-term pain relief following cervical radiofrequency neurotomy.
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15

McNabb, James W. A Practical Guide to Joint and Soft Tissue Injection and Aspiration. Lippincott Williams & Wilkins, 2004.

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16

Moyer, William. A Guide to Equine Joint Injection. Veterinary Learning Systems, 1997.

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17

Moyer, William. A Guide to Equine Joint Injection. 3rd ed. Veterinary Learning Systems, 2002.

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18

Narouze, Samer N. Atlanto-Axial Joint Injection: Ultrasound. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199908004.003.0011.

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The atlanto-axial joint accounts for up to 16% of patients with occipital headache. Distending the lateral atlanto-axial joint with contrast agent produces occipital pain, and injection of local anesthetic into the joint relieves the headache. The clinical presentation of atlanto-axial joint pain is not specific and therefore cannot be used alone to establish the diagnosis. The only means of establishing a definite diagnosis is a diagnostic block with intra-articular injection of local anesthetic. Intra-articular steroids are effective in short-term relief of pain originating from the lateral atlanto-axial joint. The major complication and limitation of the fluoroscopy-guided approach is the inability to identify and hence avoid vertebral artery injury. This chapter describes a new ultrasound-guided approach that will add more safety to the procedure.
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19

Waldman, Steven D. Atlas of Pain Management Injection Techniques. 2nd ed. Saunders, 2007.

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20

Rheumatology Examination and Injection Techniques. W.B. Saunders Company, 1992.

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21

Perry, Julian David, Brian L. Hazleman, Charles W. Hutton, Peter J. Maddison, and Michael Doherty. Rheumatology Examination and Injection Techniques. 2nd ed. Saunders Ltd., 1999.

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22

Pandey, Anil Kumar, and Sureshwar Pandey. Intra-Articular Injections. McGraw-Hill Professional, 2006.

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23

Pandey, Anil Kumar, and Sureshwar Pandey. Intra-Articular Injections. 2nd ed. McGraw-Hill Professional, 2006.

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24

Practical Procedures in Orthopaedic Surgery: Joint Aspiration/Injection, Bone Graft Harvesting and Lower Limb Amputations. Springer, 2011.

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25

Giannoudis, Peter V. Practical Procedures in Orthopaedic Surgery: Joint Aspiration/Injection, Bone Graft Harvesting and Lower Limb Amputations. Springer London, Limited, 2011.

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26

Smith, Jay, and Jacob Sellon. Elbow Injections: Ultrasound. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199908004.003.0044.

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This chapter discusses sonographically guided elbow, tendon, and joint procedures used in the management of patients presenting with tendon and joint disorders of the elbow. Two sonographically guided corticosteroid injection techniques have been used for common extensor tendinosis, a superficial technique and a deep technique. Sonographically guided percutaneous longitudinal tenotomy has also been described for chronic flexor-pronator tendinosis. Distal biceps tendinopathy is a broad term that includes both inflammatory (tendinitis) and chronic degenerative (tendinosis) conditions. As the proximal portion of the distal biceps tendon can be easily palpated anteriorly, an anterior injection approach will typically provide uncomplicated access to the tendon and/or adjacent bursal fluid. Common elbow conditions are amenable to intra-articular elbow aspiration and injections (typically with corticosteroid).
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27

Herman, Mira, Amaresh Vydyanathan, and Allan L. Brook. Sacroiliac Joint Injections: Computed Tomography. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199908004.003.0039.

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Sacroiliac (SI) joint disease is a common cause of low back pain. It is not easily diagnosed by physical examination, as the joint has limited mobility and referral patterns are not sufficiently delineated from other pathological conditions implicated in low back pain. The accuracy of provocative testing of the sacroiliac joint is controversial. Many physicians use injection of the SI joint with local anesthetic and/or steroid as a diagnostic and therapeutic tool in treating SI joint–related pain. Historically, SI joint intra-articular injections have been performed without imaging guidance. Imaging-guided techniques, often using CT fluoroscopy, increase the precision of these procedures and help confirm needle placement while achieving better results and reduced complications rates. Sacroiliac joint injection is routinely performed on an outpatient basis. The patient is questioned regarding previous steroid use (oral, cutaneous, or injected) to avoid iatrogenic Cushing syndrome. Repeat injections can be administered depending on patient’s response.
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28

Pandey, Sureshwar, and Anil Kumar Pandey. Intra-Articular and Allied Injections. Jaypee Brothers Medical Publishers, 2005.

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29

Pandey, Anil. Intra-articular and Allied Injections. Jaypee Brothers Medical Publishers (P) Ltd., 2005. http://dx.doi.org/10.5005/jp/books/10399.

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30

Pandey, Sureshwar. Intra-Articular and Allied Injections. Jaypee Brothers Medical Publishers, 2017.

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31

Foster, Brogan, and Paul A. Brogan. Specialized therapeutic approaches. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198738756.003.0008.

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This chapter provides updated guidance on specialized therapeutic approaches relevant to paediatric rheumatology. Detailed overviews include: intra-articular injections including guidance on triamcinolone hexacetonide and dose for paediatric joint injection; current indications and recommended doses for biologic therapies, including updated summaries of regulatory approvals for the use of these treatments; an overview of medicines commonly used in paediatric rheumatology, including a commentary on paediatric pharmacokinetics and specific safety issues; dose calculation in paediatric practice; and practical advice when considering different medicine formulations in paediatric practice. An important feature of the second edition is a fully updated section on haematopoietic stem cell transplantation for autoimmune and autoinflammatory diseases, providing a comprehensive and up-to-date overview of the subject.
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32

Abhishek, Abhishek, and Michael Doherty. Treatment of calcium pyrophosphate deposition. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199668847.003.0052.

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The treatment of calcium pyrophosphate crystal deposition (CPPD) is mainly symptomatic. Acute calcium pyrophosphate (CPP) crystal synovitis should be treated with rest, local application of ice packs, joint aspiration, and/or intra-articular corticosteroid injection (once joint sepsis has been excluded). Oral colchicine or prednisolone may be used if joint aspiration and/or injection are not feasible. Anti-inflammatory agents (with proton pump inhibitors) may be used but in general these should be avoided as most patients with acute CPP crystal arthritis are elderly, and at a high risk of gastrointestinal and renal complication of non-steroidal anti-inflammatory drug (NSAIDs). Principles of management of CPPD with osteoarthritis (OA) are identical to those for isolated OA. However, patients may have more inflammatory signs and symptoms and periodic joint aspiration and corticosteroid injection may be required more often than in isolated OA. Oral NSAIDs (with gastro-protection), colchicine, low-dose corticosteroids, hydroxychloroquine, and radiosynovectomy have been suggested as options for the treatment of chronic CPP crystal arthritis. There is growing interest in use of anti-interleukin-1 agents for acute or chronic CPP crystal arthritis but the efficacy of these agents has not been formally studied, and their use should be considered on an individual basis.
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33

van Eerd, Maarten, Arno Lataster, and Maarten van Kleef. Cervical Facet Nerve Block and Radio Frequency Ablation: Fluoroscopy. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199908004.003.0007.

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In the cervical spinal column local anesthetic can be injected intra-articularly or adjacent to the ramus medialis (medial branch) of the ramus dorsalis of the segmental nerve. Nerve blocks of the ramus medialis are preferred to an intra-articular block, because it is sometimes technically difficult to position a needle into the facet joint. These procedures are typically performed under fluoroscopy, but there are increasing numbers of studies that describe these procedures with the help of ultrasound. Reports regarding the effects of intra-articular (steroid) injections are limited. There are no comparative studies between intra-articular steroid injections and radiofrequency (RF) therapy. Based on literature about the efficacy of RF treatment and a long track record of safety of RF treatment, many pain practitioners abandon intra-articular injections in favor of RF treatment.
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34

Foster, Helen, and Paul A. Brogan, eds. Specialized therapeutic approaches. Oxford University Press, 2012. http://dx.doi.org/10.1093/med/9780199592630.003.0008.

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Corticosteroid intra-articular injections 390Biologic therapies for paediatric rheumatological diseases 393Approvals for use of biologic therapies 399Medicines for children and paediatric rheumatology 401Haematopoietic stem cell transplantation 405(See also BSPAR guidelines for treatments used in paediatric rheumatology, p 415)Intra-articular corticosteroid injections are increasingly used as they allow rapid symptom control and allow time for other therapies, such as methotrexate (MTX) to have their effect. They often remove the need for the use of oral or IV corticosteroids and avoidance of side effects. There is no limit to the number of joints that can be injected at any one time or the total dose of corticosteroid....
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35

Souzdalnitski, Dmitri, Adam Kramer, and Maged Guirguis. Sacroiliac Joint Injections: Fluoroscopy. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199908004.003.0038.

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Sacroiliac joint (SIJ) injections are valuable tools for diagnosing the source of low back pain and selecting patients for a radiofrequency ablation procedure, which tends to provide long-term relief for low back pain associated with SIJ dysfunction. Sacroiliac joint injections are generally safe and well-tolerated procedures. The most common complication is initial pain from distension of the joint capsule with contrast and local anesthetic. Despite adequate intra-articular needle placement, extravasation of local anesthetic may diffuse to lumbosacral nerve roots and/or the sciatic nerve, causing transient numbness and/or weakness. This chapter reviews the advantages of fluoroscopically guided SIJ injections as well as the step-by-step technique and how to avoid complications.
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36

MD, James W. McNabb. A Practical Guide to Joint & Soft Tissue Injections. LWW, 2014.

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37

Zhang, Weiya, and Michael Doherty. Guidelines. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199668847.003.0037.

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A number of treatment guidelines have been developed to optimize the treatment of osteoarthritis, some of which were recently updated. Fifty-one non-pharmacological, pharmacological, and surgical treatments are addressed in these guidelines but only two (oral opioid and intra-articular steroid injection) reach the minimal clinically important difference above placebo. Recommendations for these treatments vary depending on joint sites, risk:benefit ratio, and population. Exercise, self-management, and weight reduction if obese are universally recommended. While topical non-steroidal anti-inflammatory drugs (NSAIDs) remain a safe first-line drug option, the safety of paracetamol, the universally recommended first-line oral analgesic is increasingly questioned. Other analgesics such as oral NSAIDs (including selective cyclooxygenase 2 inhibitors), opioids, and antidepressants should be used according to patient characteristics and comorbidities. Nutraceuticals and complementary medicines remain controversial. While lavage is not recommended, total joint replacement is still considered as an effective treatment for the later stage of the disease irrespective of lack of placebo (sham) controlled trials. Stratified care has been attempted for recommendation according to joint affected and comorbidities but there is no evidence to support whether this can improve treatment outcomes. Guideline development groups differ in their composition and methodology. While the overall quality of guidelines has been improved, their applicability remains poor. Of the various factors that may influence implementation, suboptimal publishing and the efficacy paradox need to be recognized as important barriers.
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38

Agarwal, Anil, Neil Borley, and Greg McLatchie. Orthopaedics. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199608911.003.0016.

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This chapter on orthopaedics outlines the application of a secondary cast to a forearm or leg manipulation under anaesthetic (MUA) of distal radius fracture plus minus insertion of Kirschner wires, intra-articular injections, joint aspirations, and diagnostic arthroscopy. Operations included are fixation of Weber B fracture of ankle, dynamic hip screw (DHS) for extra-capsular neck of femur fracture, fixation of patella fracture by tension band wiring, insertion of traction pins, surgical debridement of traumatic wound, fasciotomy for compartment syndrome of leg, carpal tunnel decompression, surgical approaches to the hip, surgical approach to great toe metatarsophalangeal (MTPJ), and surgical approach to lumbar spine.
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39

Costandi, Shrif, Youssef Saweris, Michael Kot, and Nagy Mekhail. Thoracic Facet Nerve Block: Fluoroscopy. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199908004.003.0015.

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The benefit of intra-articular local anaesthetic and steroid injections for the diagnosis and treatment of facet joint pain is controversial. Thoracic facet medial branch blocks are mainly used to confirm the diagnosis of thoracic facet arthropathy. Anatomic variability is blamed for failed treatments. Conventionally, thermal radiofrequency (RF) has been used to denervate thoracic facet joints. Cooled radiofrequency ablation (c-RFA) of the thoracic medial branch is emerging as a novel promising technique that provides relatively larger lesions that could compensate for the anatomic variation of these branches and improve outcomes. The most feared complication of RF procedures in the thoracic region is pneumothorax, which may manifest as shortness of breath or pain with inspiration. Using proper technique for placement of the needles under fluoroscopic guidance renders the risk of this complication almost negligible.
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40

Wenham, Claire Y. J., and Philip G. Conaghan. Osteoarthritis—management. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0140.

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Osteoarthritis (OA) is a common condition which often causes pain and functional limitation, significantly impacting on a person's quality of life. A comprehensive assessment of the impact of OA should be performed before selecting therapies and treatment goals. Current recommended therapies include a combination of pharmacological and non-pharmacological therapies, which should be considered for all people with OA, regardless of anatomical site of involvement. Non-pharmacological treatments include education, muscle strengthening and aerobic exercises, weight loss if appropriate, splints and devices, and aids. Pharmacological therapies include paracetamol, oral and topical non-steroidal anti-inflammatory drugs, topical capsaicin, intra-articular corticosteroid injections, and opioids. Many existing therapies have only a small analgesic effect size and, in the case of drug therapies, may be associated with important side effects, so an individual's symptoms and comorbidities must be taken into account when selecting therapies. For those who do not respond to these treatments, surgery such as a total joint arthroplasty may be required. There is a strong need for new analgesic treatments for OA. As it is becoming increasingly clear that the sources of pain in OA are complex and multifactorial, future treatments for OA will need to target both peripheral and central pain mechanisms.
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