A new and exciting feature of the 4th edition of the Clinical Sports Medicine Textbook is the introduction of online masterclasses. A component of these masterclasses is a series of videos focusing on musculoskeletal injections. Musculoskeletal injections (including cortisone, autologous blood and aspiration of unwanted fluid) are a common treatment procedure in sports clinics and can also provide diagnostic information. Common conditions treated by injection include tennis elbow, De Quervain syndrome, plantar fasciitis, greater trochanteric and subacromial bursitis. Professor Karim Khan notes injection techniques are often difficult to teach. Choosing the appropriate patients requires both clinical experience and up to date knowledge of stages of inflammation and healing, and knowledge of appropriate pharmacological agents (including dosage and preparation). The CSM4ed masterclasses are a great resource for clinicians. Below is a table summarising the videos presented online.
Doctor Mark Hutchinson, professor of Orthopaedics and Sports Medicine at the University of Illinois Medical Centre (previously mentioned in our blog titled ‘Knee exam and other good stuff! 3 million views on YouTube’) does a brilliant job at demonstrating injection techniques for common musculoskeletal presentations. Dr Hutchinson uses a logical approach to navigate anatomical landmarks and obtain the correct placement of the needle. Dr. Hutchinson reports that historically, cortisone injections were the injection of choice but within the last decade a number of new and exciting alternative treatments have been developed with promising results and fewer risks. This is especially the case in the treatment of tendinopathies with autologous blood and platelet rich plasma (PRP) injections, sclerotherapy and prolotherapy techniques.
Not only can injections provide analgesic and powerful anti-inflammatory effects but they also have the potential to improve healing and reduce time away from sport. However clinicians should normally trial conservative treatment such as a relative period of rest, ice, analgesic medications, physiotherapy and therapeutic exercise as a first-line treatment. Where conservative measures fail, injectable interventions may be explored.