Injections and techniques in athletic medicine.

The use of corticosteroids in the treatment of athletic injuries can provide dramatic relief of pain and inflammation. The proper use of injectable steroids must be carefully understood to avoid complications. It is critical to know the anatomy and use your needle as carefully as you would a scalpel. Bring the anatomy close to you so that you can use the shortest delivery system and the smallest caliber needle. Have the patient in an optimal position: sitting up for subacromial injections, lying supine for anterior shoulder injections with rotation of the anatomy under your fingers until the area is specifically identified, lying prone for posterior shoulder problems, and sitting up for knee injections, especially for the tibial collateral ligament bursa. Remember that injection of the material should be free and easy. Resistance means you are not in planes between tissues but in the tissue, which is not desirable. Understand the importance of a therapeutic test for both diagnostic and treatment purposes. Judicious use of any medication is critical in the treatment armamentarium, including injectable corticosteroids. Remember that an injection does not substitute for a well-managed rehabilitation program. The key to the successful treatment of an athletic injury is predicted on an accurate diagnosis and a well-managed treatment program.