- Significant Tendon Injury or partial rupture
- Recent or multiple injections at the same site
- Avoid repeat injection within 3-4 months
- Infection (overlying Cellulitis, bacteremia)
- Uncontrolled Diabetes Mellitus
-
Coagulopathy
- Specific adverse effects
- Tendon rupture or atrophy
- Fistula formation from the tendon sheath
- Z-Tracking needle (redirecting needle when within subcutaneous fat) reduces fistula risk
-
General injection related adverse effects
- Local infection
- Bleeding
- Systemic effects of Corticosteroids (e.g. Hyperglycemia)
- LAST Reaction (e.g. intravascular injection of Anesthetic)
- See regional indications above for specific tendon approaches
-
Informed Consent
- Identify landmarks (anatomy, Ultrasound) and mark injection site
- Prepare injection site (e.g. Chlorhexidine, Povidone Iodine)
- Insert needle (consider z-tracking), advancing slowing and stopping if Paresthesia
- Aspirate for intravascular location
- Inject slowly at insertion site
- Warrington (2023) Crit Dec Emerg Med 37(1): 14-5
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