Arthrocentesis in primary care

Guide to arthrocentesis and soft tissue injection. Bruce Carl Anderson. Philadelphia: Elsevier Saunders, 2005 (xi + 214 pp). ISBN: 1 4160 2205 8.

Musculoskeletal diseases, or their symptoms, are commonly seen in medical practice. While the management of patients with these symptoms depends on the diagnosis, the symptoms are, for the most part, self-limiting, particularly if not associated with obvious clinical signs. For this reason a variety of therapeutic measures is often advocated, their nature depending on the training and experience of the consulted practitioner. In his preface, Bruce Anderson, Clinical Associate Professor in the medical orthopedic department of Oregon Health Sciences University, urges that “it is time to discard the notion that injuries to the soft tissues are strictly under the auspices of the department of surgical orthopedics and that injuries and inflammations of joints are strictly under the purview of the department of rheumatology”. The book’s A5 size suggests that it is to be carried in the pocket and used as a reference. Sections of one or two pages note diagnosis and treatment of many common musculoskeletal symptoms, described regionally. While most sections carry a diagram of a needle and the local anatomical area, the book tries to describe much more than the title suggests. In each section an eight or nine point sequence of treatments is listed, including all the common modalities used for musculoskeletal symptoms. Injection is not always advocated. Indeed, the book is more about lists of what might be done for a variety of musculoskeletal symptoms, than a critical appraisal of what works and what doesn’t. Further, it is probably more applicable to North American practice, where patients select the specialist that they wish to attend. There is an interesting comment in the radiology list for the ankle and lower leg (page 199), describing a “mortis” view instead of a mortice. Is death a likely complication of injection treatment? Many orthopaedic surgeons would consider that intra-articular injections of steroids may indeed mean “death” to the joint! Sydney Nade Clinical Professor of Orthopaedic Surgery University of Sydney, NSW