What are the office-based musculoskeletal procedures?

Office-Based Musculoskeletal Procedures

Office-based musculoskeletal procedures include joint or soft tissue injections, joint aspirations, nerve blocks, and various diagnostic and therapeutic techniques that can be performed safely in an outpatient setting to manage musculoskeletal conditions.

Diagnostic Procedures

• Joint aspiration and examination of synovial fluid - For diagnosis of unexplained effusions, crystal arthropathies, or infection 1, 2
• Diagnostic ultrasound - For visualization of soft tissue structures and guided interventions 1, 3, 4
• Arthroscopy - For direct visualization of joint structures 1
• Capillaroscopy - For assessment of microcirculation 1
• Disc aspiration and biopsies - For diagnosis of spinal conditions 1, 3
• Fine needle aspiration cytology (FNAC) - For obtaining tissue samples for diagnosis 3
• Core needle biopsy (CNB) - For obtaining larger tissue samples 3

Therapeutic Injection Procedures

Joint Injections

• Intra-articular corticosteroid injections - For inflammatory joint conditions including:
  • Rheumatoid arthritis
  • Osteoarthritis
  • Acute gouty arthritis
  • Psoriatic arthritis
  • Juvenile rheumatoid arthritis 1, 5

Soft Tissue Injections

• Tendon sheath injections - For tenosynovitis and tendinopathies:
  • Biceps tendon
  • Flexor digitorum longus
  • Posterior tibial tendon
  • Iliopsoas tendon 4
• Bursa injections - For bursitis conditions:
  • Subacromial bursitis
  • Trochanteric bursitis
  • Olecranon bursitis
  • Prepatellar bursitis 1, 5, 6
• Epicondylitis treatment - For lateral or medial epicondylitis 1, 3
• Plantar fasciitis treatment - For heel pain 3
• Morton's neuroma injections - For interdigital neuroma pain 3, 4
• Ganglion cyst treatment - For wrist and hand ganglia 3, 4

Regional Nerve Blocks

• Epidural and regional nerve blocks - For pain management 1
• Carpal tunnel injections - For median nerve compression 1
• Tarsal tunnel injections - For posterior tibial nerve compression 4

Other Therapeutic Procedures

• Manipulation and mobilization techniques - For joint restrictions 1
• Puncture and lavage of calcifications - For calcific tendinopathy 3
• Drainage procedures:
  • Juxta-articular fluid collections
  • Abscesses
  • Hematomas
  • Baker's cyst drainage 3

Technical Considerations

Anesthesia

• Local infiltration anesthesia - Using lidocaine, prilocaine, bupivacaine, etc. 1
• Topical anesthesia - For superficial procedures 1
• Ethyl chloride spray - For quick superficial anesthesia 1

Procedural Guidance

• Ultrasound guidance - Improves accuracy and safety of injections and aspirations 3, 4
• CT guidance - For deeper structures or complex procedures 3
• Landmark-based techniques - For easily accessible structures 7, 2

Safety Considerations

• Aseptic technique - Essential for all procedures to prevent infection 3
• Informed consent - Required before performing any procedure 3
• Knowledge of anatomy - Critical for safe and effective procedures 7, 3
• Awareness of complications - Including infection, bleeding, tendon rupture, and systemic effects of medications 5
• Appropriate patient selection - Considering contraindications and comorbidities 6

Benefits of Office-Based Procedures

• Improved patient access to musculoskeletal treatments 6
• Cost-effective compared to specialist referrals 6
• High patient satisfaction with primary care-performed procedures 6
• Comparable safety and outcomes to specialist-performed procedures 6

Office-based musculoskeletal procedures are valuable tools for primary care physicians and specialists to diagnose and treat common musculoskeletal conditions, providing timely relief and improving patient outcomes when performed with proper technique and precautions.