What are the recommendations for proceeding with a planned right acromioclavicular (AC) joint injection using a corticosteroid, such as triamcinolone acetonide, in a 62-year-old male patient?

Recommendations for Right Acromioclavicular (AC) Joint Injection

Proceeding with the planned right AC joint injection using triamcinolone acetonide is appropriate, but ensure proper technique, patient education about post-injection care, and monitoring for potential side effects.

Injection Procedure Recommendations

• Aseptic technique is essential when performing intra-articular injections to minimize infection risk 1
• Use triamcinolone acetonide as the preferred corticosteroid agent:
  • A dose of 20-40 mg triamcinolone is typically effective 2
  • Consider offering local anesthetic along with the corticosteroid to reduce procedural pain 1
• Consider using ultrasound guidance if available to improve accuracy and reduce procedural pain 2

Post-Injection Care Instructions

• Advise the patient to avoid overuse of the injected joint for 24 hours following the injection, but complete immobilization is discouraged 1, 3
• Recommend managing post-injection discomfort with:
  • Rest
  • Cold application
  • Simple analgesics (avoid NSAIDs for 24-48 hours as they might interfere with the therapeutic effect) 3
• Inform the patient that the therapeutic effect may be temporary, with studies showing an average duration of improvement of approximately 20 days (range from hours to 3 months) 4

Special Considerations

For Diabetic Patients

• If the patient has diabetes, inform them about the risk of transient increased blood glucose following intra-articular corticosteroid injection 1
• Advise diabetic patients to monitor glucose levels particularly from the first to third day post-injection 1

For Patients on Anticoagulants

• Intra-articular therapy is not contraindicated in people taking antithrombotic medications unless bleeding risk is high 1

For Patients Planning Joint Replacement

• If the patient is planning for joint replacement surgery, the injection should be performed at least 3 months prior to the surgery 1, 3
• If the patient has been indicated for total joint arthroplasty and nonoperative therapies have been ineffective, proceeding to surgery without delay is conditionally recommended rather than delaying for additional intra-articular glucocorticoid injections 1

Follow-up Recommendations

• Consider limiting the frequency of injections into the same joint (recommendations suggest no more than one injection every 6 weeks and no more than 3-4 in one year) 5
• The decision to reinject should take into consideration benefits from previous injections and other individualized factors 1
• If symptoms persist despite injection therapy, consider other treatment options including possible surgical intervention (e.g., distal clavicle excision) 4

Potential Adverse Effects to Monitor

• Local tissue reactions
• Temporary adrenal suppression (cortisol suppression may last approximately 4-5 days) 6
• Potential cartilage damage with repeated injections
• Rare risk of infection

By following these evidence-based recommendations, you can safely proceed with the planned right AC joint injection for your 62-year-old male patient.