Intra-articular Lidocaine Injection Research Articles

CORR Insights®: Is Ultrasound-guided or Landmark-guided Intra-articular Lidocaine Injection More Effective for Pain Control in Anterior Shoulder Dislocation Reduction? A Randomized Controlled Trial.

CORR Insights®: Is Ultrasound-guided or Landmark-guided Intra-articular Lidocaine Injection More Effective for Pain Control in Anterior Shoulder Dislocation Reduction? A Randomized Controlled Trial.

Additional Effect of Extracorporeal Shockwave Therapy with Lidocaine Injection on Clinical and MRI Findings in Frozen Shoulder: A Prospective, Randomized, Double-Blinded, Placebo-Controlled Trial.

Frozen shoulder is a very common musculoskeletal condition and the evidence related to the additional effects of extracorporeal shockwave therapy (ESWT) with intra-articular (IA) lidocaine injection in individuals with frozen shoulder is rare. Therefore, this study aims to compare and investigate the additional effects of extracorporeal shockwave therapy (ESWT) with intra-articular (IA) lidocaine injection in a frozen shoulder. Sixty eligible participants with frozen shoulder were included and the active group (n = 30, age 52.12 ± 5.2years) received a lidocaine injection (1% lidocaine (Xylocaine) and 2cc (80 mg) methylprednisolone acetate) with active ESWT (3.5 bar air pressure and 2000 pulses with an energy flux density (EFD) ¼ 0.16 mJ/mm2) three sessions a week for 4 weeks. The placebo group (n = 30, age 53.56 ± 5.5years) received lidocaine injection with placebo treatment (a special head that blocked the shock waves) three sessions a week for 4 weeks. Both groups received progressive resistance exercises (PRE) to the shoulder muscles. The primary outcome was pain intensity, measured with the visual analogue scale. The other outcome measures were the thickness of the coracohumeral ligament (CHL) measured by magnetic resonance imaging (MRI), abduction, and lateral rotation range of motion (ROM), functional disability, kinesiophobia, depression status, and quality of life. Participants were assessed at baseline, after 4 weeks, 8 weeks, and at 6-month follow-up. The post-intervention at 4 weeks showed an improvement of 2.0 (CI 95% 1.71-2.28) in the active group compared to the placebo group. Similar effects were noted after 8 weeks (2.2) (CI 95% 1.91-2.48) and at the 6-month (1.9) (CI 95% 1.61-2.18) follow-up. Similar improvements were also found in the thickness of the CHL ligament (0.6) (CI 95% 0.46-0.73), abduction and lateral rotation (ROM) (-23.6) (CI 95% -27.47 to -19.72), (-18.10) (CI 95% -19.72 to -16.47), functional disability (16.2) (CI 95% 14.85-17.54), kinesiophobia (11.0 (CI 95% 10.21-11.98), depression status (4.4) (CI 95% 4.03-4.76) and quality of life (0.9) (CI 95% 0.79-1.00) (p = 0.001) at the 6-month follow-up period, where mean estimates and their confidence intervals all included worthwhile effects. There were no adverse reactions or side effects noted in either the active or placebo groups during and after the treatment. The study concluded that the addition of extracorporeal shockwave therapy after intra-articular lidocaine injection improves pain, functional disability, range of motion, kinesiophobia, depression status, and quality of life in people with frozen shoulder. https://ctri.nic.in , identifier; CTRI/2020/04/024834 prospectively registered on 24/04/2020.

Is Ultrasound-guided or Landmark-guided Intra-articular Lidocaine Injection More Effective for Pain Control in Anterior Shoulder Dislocation Reduction? A Randomized Controlled Trial.

Effective pain control during reduction of shoulder dislocation is essential for patient comfort. However, there is a lack of comprehensive research comparing the efficacy of different pain management techniques, specifically landmark-guided and ultrasound-guided intra-articular analgesic injections. Among patients undergoing closed reduction of a shoulder dislocation, were there differences between an intra-articular shoulder injection placed using anatomic landmarks and an ultrasound-guided intra-articular injection in terms of (1) pain before versus after the injection and pain before injection versus after the reduction, or (2) length of stay in the emergency department and complications of the procedure? Between August 2021 and March 2023, 28 patients with anterior shoulder dislocation were treated at the emergency department of a tertiary referral care center. They were randomly assigned to either the landmark-guided or ultrasound-guided intra-articular lidocaine injection group. Differences in pain levels between preinjection and postinjection, preinjection and postreduction, length of hospital stay, and complications were assessed and compared between the two groups. Patients were followed for 2 weeks. There were no between-group differences in terms of age, gender, baseline pain score, and any other relevant factors. There were no differences between the groups in terms of pain reduction between preinjection and postinjection (landmark-guided: ΔVAS 2.8 ± 1.1, ultrasound-guided: ΔVAS 2.9 ± 1.0, mean difference -0.14 [95% confidence interval -0.97 to 0.68]; p = 0.72) or between preinjection and postreduction (landmark-guided: ΔVAS 6.6 ± 2.1, ultrasound-guided: ΔVAS 5.8 ± 1.8, mean difference 0.79 [95% CI -0.74 to 2.31]; p = 0.30). There were no differences in length of stay in the emergency department (landmark-guided: 162 ± 38 minutes, ultrasound-guided: 184 ± 73 minutes, mean difference 22 minutes [95% CI -67 to 24]; p = 0.33), and no complications were reported in either group during the 2-week follow-up period. The results of the landmark-guided technique were not different from those of ultrasound-guided injection in terms of lower pain levels, length of stay, and complications. These findings provide valuable guidance for orthopaedic surgeons, enabling them to make informed decisions based on their expertise and available resources. Level I, therapeutic study.

Assessment of Pain and Functional Outcome between Intra-Articular Corticosteroids and Platelet Rich Plasma (Prp) in Treatment of Knee Osteoarthritis: A Prospective Observational Cohort Study

Background-Osteoarthritis is the most prevalent type of arthritis, which significantly impacts the patient’s mobility and quality of life. Although pharmacological treatments like corticosteroids can provide immediate pain relief and enhance mobility and quality of life for osteoarthritis patients, their long-term effectiveness is limited. Material and Method- Forty patients affected by symptomatic radiologically confirmed knee osteoarthritis (Kellgren Lawrence grades II–III) were enrolled in this study. In the study, 30 patients were assigned to the PRP group and received a 5 mL intra-articular injection of PRP, while another 30 patients were randomized to the corticosteroid group and received an intra-articular injection of triamcinolone acetonide (2 mL of 40 mg/mL) and lidocaine (3 mL of 2%). The VAS, IKDC, and WOMAC scales were used to evaluate pain and function of the target knee at baseline, 1.5 months, and 3 months after treatment.

Assessment of Pain and Functional Outcome between Intra-Articular Corticosteroids and Platelet Rich Plasma (Prp) in Treatment of Knee Osteoarthritis: A Prospective Observational Cohort Study

Background-Osteoarthritis is the most prevalent type of arthritis, which significantly impacts the patient’s mobility and quality of life. Although pharmacological treatments like corticosteroids can provide immediate pain relief and enhance mobility and quality of life for osteoarthritis patients, their long-term effectiveness is limited. Material and Method- Forty patients affected by symptomatic radiologically confirmed knee osteoarthritis (Kellgren Lawrence grades II–III) were enrolled in this study. In the study, 30 patients were assigned to the PRP group and received a 5 mL intra-articular injection of PRP, while another 30 patients were randomized to the corticosteroid group and received an intra-articular injection of triamcinolone acetonide (2 mL of 40 mg/mL) and lidocaine (3 mL of 2%). The VAS, IKDC, and WOMAC scales were used to evaluate pain and function of the target knee at baseline, 1.5 months, and 3 months after treatment.

Assessment of Pain and Functional Outcome between Intra-Articular Corticosteroids and Platelet Rich Plasma (Prp) in Treatment of Knee Osteoarthritis: A Prospective Observational Cohort Study

Background-Osteoarthritis is the most prevalent type of arthritis, which significantly impacts the patient’s mobility and quality of life. Although pharmacological treatments like corticosteroids can provide immediate pain relief and enhance mobility and quality of life for osteoarthritis patients, their long-term effectiveness is limited. Material and Method- Forty patients affected by symptomatic radiologically confirmed knee osteoarthritis (Kellgren Lawrence grades II–III) were enrolled in this study. In the study, 30 patients were assigned to the PRP group and received a 5 mL intra-articular injection of PRP, while another 30 patients were randomized to the corticosteroid group and received an intra-articular injection of triamcinolone acetonide (2 mL of 40 mg/mL) and lidocaine (3 mL of 2%). The VAS, IKDC, and WOMAC scales were used to evaluate pain and function of the target knee at baseline, 1.5 months, and 3 months after treatment

The concentration of lidocaine and mepivacaine measured in synovial fluid of different joints of horses after single intra-articular injection.

To determine the synovial fluid (SF) concentrations of lidocaine and mepivacaine after intra-articular injection with clinically relevant doses to the distal interphalangeal (DIP), metacarpophalangeal (MCP), middle carpal (MC), and tarsocrural (TC) joint at two different time points after injection in order to be able to compare concentrations with previously established concentrations associated with cytotoxicity and antimicrobial activity. In the first of two experiments, 20 joints (5 MC, 5 MCP, 10 DIP joints) of five horses under general anesthesia were injected with clinically referenced doses of 2% lidocaine. Simultaneously, the horses had 19 joints (5 MC, 5 MCP, 9 DIP joints) injected with clinically referenced doses of 2% mepivacaine. Synovial fluid samples were collected ~7 min after injection. In experiment 2, 23 joints of seven horses under standing sedation were injected with clinically referenced doses of 2% lidocaine. Similarly, the horses had 21 joints injected with 2% mepivacaine. Synovial fluid samples were collected ~23 min after injection. The concentration of mepivacaine and lidocaine in the obtained SF samples was assessed using high-performance-liquid-chromatography with mass spectrometry detection (HPLC MS). Synovial fluid was obtained 6.8 ± 1.5 (experiment 1) and 23 ± 4.3 (experiment 2) min following intra-articular injection of mepivacaine and lidocaine. Synovial fluid concentrations of experiment 1 for lidocaine and mepivaciane were 6.46-19.62 mg/mL (mean 11.96 ± SD 3.89 mg/mL) and 5.01-13.38 mg/mL (mean 8.18 ± SD 1.76 mg/mL), respectively. In experiment 2, concentrations were 2.94-10.40 mg/mL (mean 6.31± SD 2.23 mg/mL) for lidocaine and 2.10-8.70 mg/mL (mean 4.97 ± SD 1.77 mg/mL) for mepivacaine. Intra-articular LA injections in horses resulted in SF concentrations above those previously associated with cytotoxic effects in vitro but also above those associated with beneficial antimicrobial activities. Local anesthetic concentration was 33-60% lower after 23 min (experiment 2) than after 7 min (experiment 1).

Intra-articular lidocaine versus intravenous sedation for closed reduction of acute anterior shoulder dislocation in the emergency department: a systematic review and meta-analysis.

ObjectiveAnterior shoulder dislocations are commonly treated in the emergency department (ED). Analgesia for reduction is provided by intra-articular lidocaine (IAL) injection or intravenous sedation (IV sedation). The objective of this systematic review and meta-analysis was to compare IAL versus IV sedation for closed reduction of acute anterior shoulder dislocation in the ED.MethodsElectronic searches of MEDLINE and EMBASE (1946–September 2021) were completed and reference lists were hand-searched. Randomized controlled trials (RCTs) comparing IAL and IV sedation for reduction of acute anterior shoulder dislocations among patients ≥ 15 years old in the ED were included. Outcomes of interest included a successful reduction, adverse events, ED length of stay, pain scores, procedure time, ease of reduction, patient satisfaction, and cost. Two reviewers independently screened abstracts, assessed study quality and extracted data. Data were pooled using random-effects models and reported as mean differences and risk ratios (RR) with 95% confidence intervals (CIs).Results12 RCTs were included with a total of 630 patients (IAL = 327; IV sedation = 303). There was no difference in reduction success between IAL and IV sedation (RR 0.93; 95% CI 0.86–1.01, I2 = 69%), significantly lower adverse events with IAL (RR 0.16; 95% CI 0.07–0.33, I2 = 0%), shorter ED length of stay with IAL (mean difference − 1.48; 95% CI − 2.48 to − 0.47, I2 = 93%), no difference in pain scores post-analgesia and no difference in ease of reduction.ConclusionsIntra-articular lidocaine may have similar effectiveness as IV sedation in the successful reduction of anterior shoulder dislocations in the ED with fewer adverse events, shorter ED length of stay, and no difference in pain scores or ease of reduction. Intra-articular lidocaine may be an effective alternative to IV sedation for reducing anterior shoulder dislocations, particularly when IV sedation is contraindicated or not feasible.Supplementary InformationThe online version contains supplementary material available at 10.1007/s43678-022-00368-z.

Research in Brief

Ultrasound-guided intra-articular injection of triamcinolone and lidocaine in addition to best current treatment (advice and education) might be an effective treatment option for hip osteoarthritis, according to a pragmatic single-blind trial by Zoe Paskins and colleagues. 199 patients aged 40 years or older with hip osteoarthritis and at least moderate pain were randomly assigned to receive best current treatment (n=67), best current treatment plus ultrasound-guided injection of triamcinolone and lidocaine (n=66), or best current treatment plus ultrasound-guided injection of lidocaine only (n=66). Mean improvement in hip pain intensity over 6 months (the primary outcome; 0–10 numerical rating scale) was greater with ultrasound-guided triamcinolone and lidocaine injection than with best current treatment alone (standardised mean difference −0·55 [95% CI −0·82 to −0·27]). Hip pain intensity did not differ significantly between lidocaine injection and best current treatment alone (−0·52 [−1·21 to 0·18]). One death occurred in the triamcinolone and lidocaine group, deemed possibly related to study treatment (subacute bacterial endocarditis in a patient with a bioprosthetic aortic valve).

Chondrotoxic effects of intra-articular injection of local anaesthetics in the rabbit temporomandibular joint

The aim of this study was to investigate the chondrotoxic effects of a single-dose intra-articular injection of articaine, lidocaine, and bupivacaine on the rabbit temporomandibular joint (TMJ). Twenty-four rabbits were divided into four groups: control (group 1), articaine (group 2), lidocaine (group 3), and bupivacaine (group 4). Synovial fluid samples and venous blood were taken to evaluate matrix metalloproteinase 3 (MMP-3) levels. One millilitre of local anaesthetic solution was injected in the study groups and saline solution in the control group. The rabbits were euthanized after 4 weeks and the mandibular condyles and articular discs were evaluated. On histological examination, the study group samples had irregular joint surfaces, decreased collagen, and a thinner cartilage layer. Apoptotic cells were evaluated with the TUNEL method. TUNEL-positive apoptotic cell counts were higher in all study groups compared to the control group, and the difference was significant (P < 0.001). The mean preoperative serum MMP-3 level for all groups was 5.71 ± 3.33 ng/mL, while the mean postoperative level was 22.61 ± 6.36 ng/mL; this difference was significant (P < 0.001). A single-dose intra-articular injection of local anaesthetic had apoptotic effects on chondrocytes, leading to degenerative changes in the TMJ articular structures. Articaine was found to have less harmful effects than lidocaine and bupivacaine. Intra-articular injection of local anaesthetics should be limited in the TMJ because of the potential toxic effects.

Intra-Articular Lidocaine versus Procedural Sedation for Shoulder Dislocation Reduction: A Randomized Trial.

Two common ways of providing anesthesia for shoulder dislocation reductions in the emergency department (ED) are intra-articular lidocaine (IAL) injections and procedural sedation (PS). We sought to compare PS with propofol or etomidate to IAL for shoulder dislocation reductions in the ED. This was an open-label, randomized controlled trial of patients aged 18-70 years with anterior shoulder dislocations who presented to a single ED. We randomized patients to either PS or IAL for their shoulder dislocation reduction. The primary outcome measure was ED length of stay (LOS). Secondarily, we assessed patient satisfaction and the number of attempts required for successful reduction. We identified 60 patients who met the criteria for enrollment, and were able to enroll 43. We randomized 23 patients to IAL and 20 to PS. In the IAL group, the mean ED LOS was 133 min as compared to 124 min for the PS group (difference 9 min [95% confidence interval (CI)-22-41], P = 0.54). Patients in the IAL group required an average of 1.9 reduction attempts as compared to 1.2 in the PS group (difference of 0.7 [95% CI 0.2-1.2]). The mean patient satisfaction scores were similar at 9.7 and 9.8 for the IAL and PS groups, respectively. This study lacked a sufficient sample size to detect small differences but found no statistically significant difference in mean ED LOS or patient satisfaction for patients who received IAL as compared to PS. Patients in the PS group required fewer attempts for successful reduction.

Assessment of the duration and effectiveness of intra-articular lidocaine injections for groin pain in patients with labral tears involving early osteoarthritis

Introduction: Intra-articular lidocaine injections have been used to confirm the hip pathology and may predict the efficacy of arthroscopic surgery. We have routinely performed the injections as a surgical indicator. The aim of this study was to assess the duration and effectiveness of these diagnostic intra-articular lidocaine injections on groin pain in patients with labral tears involving early osteoarthritis. Methods: A total of 113 patients were included in this study. All patients received one injection of 10 ml of 1% lidocaine into the hip joint under fluoroscopy. The duration and effectiveness of the injection were assessed 2 weeks after the injection and at a minimum of 1 year of follow-up. The effect of the injection was graded as 0: unchanged or worse; 1: an effect only on the day of injection; 2: the effect lasted a few days; 3: the effect lasted about a week; and 4: symptom remission. In addition, we recorded whether hip arthroscopic surgery was eventually performed. Results: The effect was rated as 0 in 19 patients (16.8%), as 1 in 30 patients (26.5%), as 2 in 38 patients (33.6%), as 3 in 13 patients (11.5%), and as 4 in 13 patients (11.5%). Seventy-two patients (63.7%) underwent hip arthroscopic surgery. No relationship with patients’ characteristics was found. Conclusion: In total, 83% of patients experienced some effect of the lidocaine injection. Furthermore, 11.5% of patients experienced complete remission of their symptoms.

77 Intra-articular Lidocaine versus Procedural Sedation for Anterior Shoulder Dislocations

Shoulder dislocations are the most common dislocations presenting to emergency departments (EDs). Due to the large groups of muscles involved, shoulder dislocation reductions are difficult to achieve for the provider if the patient's pain is not adequately controlled. There are several ways of providing anesthesia for shoulder dislocation reductions, and two of the most common are intra-articular lidocaine (IAL) injections and procedural sedation. Prior studies have found that the use of IAL is safer and results in a shorter ED length of stay (LOS) as compared to procedural sedation, but those studies used sedative medications that have fallen out of favor. The purpose of this study was to compare IAL to procedural sedation with propofol or etomidate for closed reduction of anterior shoulder dislocations. This was a single center, open label, randomized controlled trial. ED patients from 18 to 70 years old who had an anterior shoulder dislocation without an associated fracture (other than a Hill-Sachs) were eligible for enrollment. Consenting patients were randomized to either procedural sedation (with provider’s choice of propofol or etomidate) or IAL. The dose of procedural sedation medication was per provider discretion. The initial study protocol stated that patients randomized to the IAL group would receive 20mL of 1% lidocaine into the glenohumeral joint, but due to a shortage of 1% lidocaine, injections with 10mL of 2% lidocaine were also allowed. The primary outcome measure was ED LOS. Secondarily the number of attempts required for successful reduction and patient satisfaction were compared between groups. In total, 43 patients were enrolled with 23 randomized to the IAL group and 20 to the procedural sedation group. Three patients randomized to the IAL group ended up getting procedural sedation after failed attempts at reduction. In those randomized to the IAL group, the mean ED LOS was 133 minutes as compared to 124 minutes for the procedural sedation group. The difference of 9 minutes (95% CI -22 to 41) was not statistically significant (p = 0.54). Patients in the IAL group had a higher mean number of reduction attempts at 1.9 as compared to 1.2 in the procedural sedation group (difference 0.7 [95% CI 0.2 to 1.2]). The mean patient satisfaction scores were similar at 9.7 and 9.8 for the IAL and procedural sedation groups, respectively (difference 0.1 [95% CI -0.3 to 0.4]). Although this study was underpowered to detect small differences, there was no statistically significant difference in mean ED LOS or patient satisfaction for patients who received IAL for their shoulder dislocation reduction as compared to those who received procedural sedation. Patients randomized into the procedural sedation group required less number of attempts for successful reduction compared to those randomized into the IAL group.

Intra-articular platelet-rich plasma vs corticosteroids in the treatment of moderate knee osteoarthritis: a single-center prospective randomized controlled study with a 1-year follow up

BackgroundOsteoarthritis is the most prevalent type of arthritis, which significantly impacts the patient’s mobility and quality of life. Pharmacological treatments for osteoarthritis, such as corticosteroids, produce an immediate reduction of the patient’s pain as well as an improvement in the patient’s mobility and quality of life, but with a limited long-term efficacy. In this context, platelet-rich plasma (PRP) infiltrations represent a therapeutic tool due to its trophic properties and its ability to control inflammatory processes, especially in musculoskeletal applications. The aim of this study is to evaluate and compare the clinical benefits of PRP when injected intra-articularly vs a commonly used corticosteroid (CS, triamcinolone acetonide, Kenalog®) in patients affected by mild to moderate symptomatic knee osteoarthritis.MethodsForty patients affected by symptomatic radiologically confirmed knee osteoarthritis (Kellgren-Lawrence grades II–III) were enrolled in this randomized study. Patients randomized in the PRP group (n = 20) received an intra-articular injection of PRP (8 mL) while patients randomized in the CS group (n = 20) received an intra-articular injection of triamcinolone acetonide (1 mL of 40 mg/mL) plus lidocaine (5 mL of 2%). The pain and function of the target knee were evaluated by the VAS, IKDC, and KSS scales at the baseline (V1), 1 week (V2), 5 weeks (V3), 15 weeks (V4), 30 weeks (V5), and 1 year (V6) after treatment.ResultsNo serious adverse effects were observed during the follow-up period. A mild synovitis was registered in 15 patients (75%) in the PRP group within the first week after treatment which resolved spontaneously. Both treatments were effective in relieving pain and improving the knee function in the very short-term follow-up visit (1 week). A high improvement of the subjective scores was observed for both groups up to 5 weeks, with no significative differences between the groups for the VAS, IKDC, or KSS. After 15 weeks of follow-up, the PRP group showed significative improvements in all scores when compared to the CS group. Overall, the patients who received PRP treatment had better outcomes in a longer follow-up visit (up to 1 year) than those who received CS.ConclusionsA single PRP or CS intra-articular injection is safe and improves the short-term scores of pain and the knee function in patients affected by mild to moderate symptomatic knee OA (with no significant differences between the groups). PRP demonstrated a statistically significant improvement over CS in a 1-year follow-up. This study was registered at ISRCTN with the ID ISRCTN46024618.

Therapeutic effect of Intra-articular normal saline and lidocaine injection after Arthrocentesis for Knee Hemarthrosis post traumatic injury in RS Muhammadiyah Palembang (RSMP): A Case Report

Female 22 years old, come to RSMP with pain and swollen in the right knee after fall down from stairs 2 days ago. In Physical Examination found bruising around the knee with no sign of crepitation nor abnormality during ligament test. Patient than given initial treatment (analgesic and antifibrinolytic) for 1 week and X-ray examination of knee. One week later patient come with decreased but persisted pain and swollen knee. X-ray Examination suggests joint effusion. The Patient than admitted for arthrocentesis followed by Intra-articular normal saline and lidocaine injection.Bleeding into a joint is referred to as hemarthrosis and is an important cause of monoarticular joint pain and swelling. Its can be suspected based on patient history, physical exam, and multiple imaging modalities, however the best way to diagnose hemarthrosis is with arthrocentesis with synovial fluid analysis. Traumatic injury is the most common cause and the knee is a frequent site of hemarthrosis. Initial treatment of any acute hemarthrosis includes immobilization, ice, and compression. Analgesia for pain control may be required in the acute period. Arthrocentesis with aspiration from a joint can be both diagnostic and therapeutic by reducing pressure from the effusion.Intra-articular normal saline (IA-NS) injections have been utilized as a placebo in a number of researches pertaining to the management of joints problem such as knee osteoarthritis (OA). It is believed that these IA-NS injections may have a therapeutic effect that has not been quantified in the literature. Lidocaine have some mild anti-inflammatory effect during its relatively short halflife of 1.5 hours. The prompt effect of the local anesthetic providing temporary relief of symptoms can help confirm proper placement of the injection and support that the site injected was the source of the pain.

The Influence of a Single Intra-Articular Lidocaine Injection on the Viability of Articular Cartilage in the Knee.

To evaluate the in vivo effect of a single intra-articular injection of local anesthetic (LA) lidocaine on the viability of articular cartilage in the intact or osteoarthritic (OA) human knees, and to measure the synovial postinjection concentration of lidocaine in the knee. This study includes 3 interconnected experiments: (A) Synovial LA concentration measurement after a 2% lidocaine injection before knee arthroscopy in 10 patients by liquid chromatography-tandem mass spectrometry (LC-MS/MS). (B) Human osteochondral explants (N = 27) from intact knees procured at autopsies were incubated for different time intervals (30 minutes, 2 hours, 24 hours) with 2% lidocaine, 0.04% lidocaine (measured), or culture medium (control), and later evaluated for cell viability by LIVE/DEAD staining. (C) Ten out of 19 matched patients scheduled for knee replacement received a single intra-articular injection of 2% lidocaine approximately 30 minutes prior to the procedure; 9 patients served as control. Osteochondral samples with OA changes were harvested during surgery and analyzed for chondrocyte viability by LIVE/DEAD staining. (A) The synovial LA concentration was significantly lower than the primary concentration injected: average 0.23 mg/mL (0.02%), highest measured 0.37 mg/mL (0.04%). (B) In vitro exposure to a reduced LA concentration had no significant influence on chondrocyte viability in intact cartilage explants (24-hour averages: control, 93%; 0.04% lidocaine, 92%; 2% lidocaine, 79%). (C) Viability of chondrocytes in OA knees was similar between 2% lidocaine injection (85%) and control (80%). A single intra-articular knee injection of 2% lidocaine did not influence the chondrocyte viability neither in healthy nor in OA cartilage. A fast postinjection reduction of synovial LA concentration (more than 40 times) is the most likely protective mechanism.

Shoulder Pseudodislocation Associated with Calcific Tendinitis/Bursitis and Diagnosed by Point of Care Ultrasound.

Shoulder pseudodislocation, or "drooping shoulder," presents with acute pain and deformity of the joint, with radiographs demonstrating inferior subluxation of the humeral head relative to the glenoid fossa. The diagnosis must be made promptly and distinguished from true glenohumeral dislocation, both to avoid unnecessary attempts at closed reduction and to facilitate investigation of the underlying cause, which may include septic arthritis, hemarthrosis, or other emergent etiologies. Point-of-care ultrasound (POCUS) may be useful in the evaluation of emergency department (ED) patients with suspected pseudodislocation. A 50-year old female presented to the ED with an acutely painful and deformed shoulder but atypical history and physical examination. Initial radiography appeared to show a glenohumeral dislocation, but POCUS, done to guide intra-articular lidocaine injection, led to recognition of pseudodislocation and subsequent diagnosis of calcific tendinitis/bursitis, a condition not previously associated with inferior humeral subluxation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Shoulder pseudodislocation must be considered in the evaluation of patients with suspected glenohumeral dislocation, but atypical features on history, physical examination, or initial plain radiography. POCUS may facilitate prompt diagnosis and identification of the underlying etiology.

Use of Ultrasound for Joint Dislocation Reduction in an Austere Wilderness Setting: A Case Report

Point-of-care ultrasound has been shown to have a demonstrable impact in the austere/out-of-hospital environment. As ultrasounds become more affordable and portable, a myriad of uses in austere environments are becoming recognized. We present a case of a stranded hiker with an ultrasound-confirmed glenohumeral joint dislocation who underwent ultrasound-guided intra-articular lidocaine injection and ultrasound-confirmed reduction. This procedure allowed the patient to hike out under his own power, avoiding the potential dangers of extrication to both patient and rescuers. We believe this case demonstrates the feasibility and utility of ultrasound in the out-of-hospital environment both procedurally and diagnostically.

Platelet-Rich Plasma versus Corticosteroid Intra-Articular Injections for the Treatment of Trapeziometacarpal Arthritis: A Prospective Randomized Controlled Clinical Trial.

Various systematic reviews have recently shown that intra-articular platelet-rich plasma (IA-PRP) can lead to symptomatic relief of knee osteoarthritis for up to 12 months. There exist limited data on its use in small joints, such as the trapeziometacarpal joint (TMJ) or carpometacarpal joint (CMCJ) of the thumb. A prospective, randomized, blind, controlled, clinical trial of 33 patients with clinical and radiographic osteoarthritis of the TMJ (grades: I-III according to the Eaton and Littler classification) was conducted. Group A patients (16 patients) received 2 ultrasound-guided IA-PRP injections, while group B patients (17 patients) received 2 ultrasound-guided intra-articular methylprednisolone and lidocaine injections at a 2-week interval. Patients were evaluated prior to and at 3 and 12 months after the second injection using the visual analogue scale (VAS) 100/100, shortened Disabilities of the Arm, Shoulder, and Hand Questionnaire (Q-DASH), and patient's subjective satisfaction. No significant differences between the baseline clinical and demographic characteristics of the 2 groups were identified. After 12 months' follow-up, the IA-PRP treatment has yielded significantly better results in comparison with the corticosteroids, in terms of VAS score (P = 0.015), Q-DASH score (P = 0.025), and patients' satisfaction (P = 0.002). Corticosteroids offer short-term relief of symptoms, but IA-PRP might achieve a lasting effect of up to 12 months in the treatment of early to moderate symptomatic TMJ arthritis.

Is intra-articular lidocaine injection a safe and effective alternative to intravenous analgesia and sedation for the manual reduction of acute anterior shoulder dislocation?

EVIDENCE-BASED ANSWER Yes. Intra-articular lidocaine has a lower risk of complications (especially hypoxia and apnea) and similar reduction success rates and pain relief with shorter length of stay than intravenous (IV) analgesia with sedation in the closed manual reduction of acute anterior shoulder dislocation in adults (SOR: B, meta-analyses of lower quality RCTs and single RCT).