Curriculum standards

Knowledge guides

LG15: Intra-articular steroid injection

Clinical sciences

Advanced Trainees will describe the principles of the foundational sciences.

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Eligibility considerations

Advanced Trainees will assess patients’ current conditions and plan the next steps.

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Less common or more complex presentations and conditions

Advanced Trainees will understand the resources that should be used to help manage patients with these presentations and conditions.

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Undertaking therapy

Advanced Trainees will monitor the progress of patients during the therapy.

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Post therapy

Advanced Trainees will know how to monitor and manage patients post-therapy.

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Important specific issues

Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management and integrate these into care.

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Anatomy of principal joints and surface markers of injection sites, such as:
- lower limb joints, including:
  - ankles
  - knees
  - metatarsophalangeal
  - proximal and distal interphalangeal
  - subtalar
- upper limb joints, including:
  - elbow
  - metacarpophalangeal
  - proximal and distal interphalangeal
  - shoulder
  - wrist
Principles of local steroid use, such as:
- different steroid preparations
- effectiveness
- side effects

Appropriateness of repeated injections
Consideration of whether image-guided injection is indicated
Pre-procedure review of examination and imaging findings
Reasons for intra-articular administration of steroids as opposed to alternative routes, such as oral or intravenous administration, based on individual patients’ clinical scenarios

Anatomy of principal joints and surface markers of complex injection sites, such as:
- axial joints, such as:
  - hip joints
  - sacroiliac
  - spinal
  - temporomandibular
- bursae injections
- mid-foot joints
- tendon sheaths

Age-appropriate analgesia / sedation:
- general anaesthesia
- local anaesthesia
- sedation, such as nitrous oxide
Aseptic technique
Aspiration of synovial fluid
Choice of steroid preparation and steroid dosage for different joints
Correct needle placement and use of imaging, such as x-ray or ultrasound, to confirm needle placement, as indicated
Identification of surface markers of injection sites
Patient and parental consent:
- expected benefits of the procedure
- risk of side effects, such as:
  - failure of procedure
  - infection
  - subcutaneous atrophy
Use of splinting / casting

Infection risk and appropriate patient / parental education / safety-netting
Return to exercise
Subcutaneous atrophy management

Multidisciplinary team involvement:
- physiotherapy and occupational therapy for splinting / casting
- radiology for image guided injections