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General Information about Intra-Articular Joint Injections

[music] The skill to correctly puncture different
joints in the horse is important for all equine
practitioners. The most frequent use of joint injections is to diagnose and
treat arthritis in performance horses. However, the ability to perform arthrocentesis is also needed when dealing, for example,
with joint infections in foals and in connection with traumatic injuries
involving joints. It is possible to access all major
joints in both the fore and the hind legs with the horse awake and in the standing position. Some joints are very easy to puncture, for example the carpal joints, while
others require more training. When infected joints are flushed or when
joint wounds are treated, tranquilizers or general anesthesia can
be used as needed. When working with lameness evaluation
however, it is not advisable to tranquilize the
patient because sedation may affect movement patterns. If needed a nose twitch is used to keep the horse still during arthrocentesis. When working with joint injections for
anesthesia or intra-articular treatment and especially
when checking for joint perforations in in trauma cases, thorough knowledge concerning the local anatomy is essential. However, if the point of
insertion is carefully located in relation to the relevant anatomical
structures and the needle aimed in the correct
direction, most joints are easy to find even for the inexperienced practitioner. Arthrocentesis must always be performed
under aseptic conditions. If aseptic techniques are carefully
observed, the risk of causing a joint infection is very low and joint injections can be
carried out safely under field conditions. To start
with, the exact point where the injection is
to be administered is located. The hair is clipped on an area large enough to allow for some movement of the skin should the horse change position after
clipping. The skin is washed several times
carefully with a skin disinfectant to obtain a sterile surface. Repeat
rubbing with new swabs of cotton soaked in
disinfectant until they remain white. If the injection is to be performed with
the leg in the flexed position, the assistant who holds the leg must be
careful never to touch the clipped sterile area. If the injection is
to be administered with the horse putting weight on the leg, the assistant lifts one of the forelegs to prevent the horse from lifting the leg that is to be injected. The veterinarian positions all non-sterile
materials, such as bottles of local anesthetics within easy reach. Non-sterile outer
packaging is also open to allow the vet to
access the sterile content after putting on sterile gloves. The
veterinarian opens the envelope containing sterile
gloves and unfolds it, taking can not to touch the inside of the
envelope. This area is now sterile and can be
used to place all sterile equipment, for example needles and syringes. The vet puts on the sterile gloves. If any sterile item or surface comes
in contact with a non-sterile object or surface at any time during the
procedures, it should immediately be changed or re-disinfected. A suitable needle size for joint injections is 21 gauge by one and a half inches. For a stifle puncture, the length should
be two inches. When the needle has been
inserted in the joint, synovial sampling and joint
injections can be performed through the same needle. After arthrocentesis, the skin at the injection point should be
washed once again with disinfectant and covered with spray plaster or bandage.

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