Hip puncture method I. Tip of the greater trochanter approach The patient is lying on his or her side, with the affected side on top. The puncture point is above the tip of the greater trochanter of the femur. After the skin is routinely disinfected, a 7-gauge long puncture needle is inserted and slowly entered into the acetabulum along the upper border of the femoral neck to the acetabular joint capsule, and a small amount of drug can be injected after there is no blood return by backdrawing; then continue to enter the joint cavity through the joint capsule. Second, the anterior approach needle method The patient is in the supine position, and the intersection of 2 cm below the inguinal ligament and 2 cm lateral to the femoral artery is the needle entry point. The skin is routinely disinfected, and the needle is inserted vertically with a No. 7 needle to reach the bone surface and then slightly withdrawn, with the tip of the needle in the joint cavity at this time. Third, the posterior approach needle method The patient is in prone position, or lateral position, with the affected side on top. At the junction of the midpoint of the greater trochanter and the middle and outer 1/3 of the line of the posterior inferior iliac spine is the needle entry point. The needle is inserted vertically or slightly upward with a No. 7 needle, and the needle is withdrawn slightly after reaching the bone surface, at which time the tip of the needle is inside the joint cavity. Knee puncture method I. Knee eye puncture method The patient is supine with the knee flexed at 45 degrees, and the depression of the lateral and medial margins under the patella is determined. The skin is routinely disinfected, a local anesthetic mound is made, and a short 3-cm-long, 7-gauge needle is used, connected to a syringe containing 3 ml of air. Puncture 2~2.5cm into the depression, inject air without resistance, then inject 3~5ml of drug. Patients with knee joint effusion can have the joint fluid withdrawn, and when it is exhausted, inject back the appropriate amount of drug. Second, the upper puncture method The patient lies supine, the knee joint is straight, the intersection of the horizontal line of the upper edge of the knee bone and the vertical line of the outer edge of the knee bone (or the inner edge) is the entry point of the needle. The skin is routinely disinfected, and a No. 7 needle is used to puncture into the joint cavity from the puncture point inwards and downwards (or outwards and downwards). If there is joint effusion, the effusion should be withdrawn and the appropriate amount of medication injected. Ankle joint puncture method I. Ankle joint cavity anterolateral entry method Xiexi point entry point operation method: the patient lies on his back or is sitting, in the middle of the transverse stripe of the ankle joint at the back of the foot, so that the long extensor tendon of the bunion is obviously elevated when the patient crosses his toes, and the point of entry is in the depression between the lateral long extensor tendon of the bunion and the long extensor tendon of the toes. The skin was routinely disinfected, and a No. 5 needle was used to pierce directly into the skin, subcutaneous tissue, and the cruciate ligament of the calf, with the body of the needle passing between the long extensor tendon of the bunion and the long extensor tendon of the toe, and the tip of the needle facing the main trunk of the dorsal artery of the foot and the dorsal branch of the deep peroneal nerve. Back to draw no blood injection 3ml, and then use dragging injection method to retreat the needle. If necessary, the needle can continue to enter through the joint capsule and into the joint cavity. If there is fluid in the joint, use an empty syringe to draw fluid and then inject the appropriate amount of medication. Second, the lateral entry method of the ankle joint cavity Kunlun point needle point operation method: the patient is sitting or lying on his back, behind the outer ankle, when the depression between the high point of the outer ankle and the Achilles tendon is the entry point. The skin is routinely disinfected. 1, oblique stab: (1) with a No. 5 needle into the medial front, stab into the skin, subcutaneous tissue, into the connective tissue between the outer ankle of the fibula and the Achilles tendon; back to draw no blood, inject 5 ml of medicine. if you continue to go deeper can enter the ankle joint cavity, aspirate no fluid and inject the medicine. (2) Use a No. 5 needle to enter the Achilles tendon stop, which can enter the subacromial bursa of the Achilles tendon; draw back no blood, no effusion, and inject 2~5ml of medicine. 2. Direct stab: It can also be directly through the Achilles tendon, and Kunlun penetrates Taixi. Third, the anterolateral approach to the ankle joint cavity Qiu Hui point into the needle operation method: the patient is sitting, lying on his side or supine, in the anterior and inferior depression of the external ankle of the foot is the point of entry; you can press the hand to find the painful point to help enter the needle. The skin is routinely disinfected, and a No. 5 dental needle is used to stab the skin, superficial fascia, and enter the tarsal sinus through the anterior aspect of the external ankle in an inward direction, and stab the ankle joint capsule; after drawing back no blood and no fluid, 5 ml of medicine is injected. Shoulder joint puncture method I. Anterior approach The upper limb is mildly abducted and externally rotated, and the elbow joint is in the flexion zone position. With a No. 6 needle, insert the needle vertically from the midpoint of the tuberosity of the humerus and the rostral process of the scapula, or 1~2 cm below the tip of the rostral process, until the tip of the needle enters the joint cavity. If there is no effusion in the retraction, the drug can be injected. If there is fluid in the retraction, the joint fluid should be pumped out and then injected. Second, the lateral approach needle point into the shoulder point operation method: make the patient shoulder joint abduction, so that the upper limb and trunk into 90 degrees, in the shoulder joint due to the contraction of the lateral part of the deltoid muscle, forming two fossa, the front one is located between the shoulder peak and the humeral tuberosity, equivalent to the shoulder point into the needle point, fixed point, so that the patient upper limb natural drooping, skin routine sterilization, with a No. 5 dental needle and the point of the lateral skin is about 60 degrees If there is fluid, the fluid should be removed and then injected. Third, the posterior approach 1, the biceps point into the needle point operation method: the patient takes a sitting position, upper arm inward, the head of the posterior axillary stripe straight up, the lower edge of the scapular gland scapular peak, with hand pressure there is a depression, for the needle point, the skin routine sterilization. The skin is routinely disinfected. The needle is stabbed directly with a No. 5 needle: the needle is stabbed forward into the skin, subcutaneous tissue, and subscapularis muscle. The suprascapular nerve and artery are located in front of the needle. The needle can be continued into the shoulder joint cavity. Back to draw no blood and no fluid to inject 5ml. 2. Posterior lateral approach: It is more suitable for the patient because it is operated away from the patient’s line of sight. The patient’s arm is internally rotated and inwardly crossed over the chest to lap to the contralateral shoulder, which can make the shoulder joint fully open. The needle is inserted from the underside of the posterior lateral angle of the acromion (1 to 2 cm) toward the tip of the rostral process, and the needle is inserted 2 to 3 cm into the joint cavity. 3.Subacromial bursa approach: The subacromial bursa is the synovial bursa between the tendon plate and the acromion, which has the function of helping the tendon plate to glide. The size of the subacromial bursa varies from person to person and forms a gap of about 1 cm when the upper limb is subluxated. The size of the subacromial bursa varies from person to person and forms a gap of about 1 cm when the upper limb is subluxated. First, the outer edge of the acromion and the angle of the acromion are palpated and the gap between the acromion and the tendon plate is determined. Elbow joint puncture method a. Elbow joint cavity posterior side into the needle method Tianjing point into the needle point operation method: the patient flexes the elbow 90 degrees, in the tip of the elbow (ulnar hawk’s mouth) straight up 1 inch depression, that is, the lower end of the humerus in the hawk’s mouth fossa for the needle point, skin routine sterilization, with a No. 5 dental needle vertical stab into the skin subcutaneous tissue, into the triceps tendon back to draw no blood can be injected 3 ml. continue into the needle can penetrate the joint capsule into the joint cavity, when through the There is a slight breakthrough sensation when passing through the joint capsule. After no blood is drawn back and no fluid is accumulated, an appropriate amount of medication is injected. Second, the elbow joint cavity hawk’s mouth medial needle method Xiaohai point into the needle point operation method: the patient forearm flexion to 90 degrees, in the depression between the ulnar hawk’s mouth and the humeral medial epicondyle, when the humeral ulnar nerve groove, for the needle point. The ulnar nerve is first felt on the skin surface with the fingers to guide the needle entry, and the skin is routinely disinfected. 1.Straight stabbing: (1)ulnar nerve injection: use No.5 needle right to the ulnar nerve, stab into the skin, subcutaneous tissue vertically, slowly enter the needle about 1cm, stab the ulnar nerve, slightly withdraw the needle if there is electric shock-like foreign sensation, draw back no blood to inject 3ml of medicine. (2)medial puncture injection of the elbow joint cavity hawser: in order to prevent ulnar nerve injury, you can first use the left thumb or finger nail to poke the ulnar nerve, then use No.7 needle to stab into the skin, subcutaneous tissue, cross the ulnar nerve, ulnar side of the upper collateral artery, stab into the elbow joint cavity, penetrate with a mild breakthrough feeling, draw out the fluid, and then proceed to drug injection. 2.Oblique (flat) stab For elbow canal injection, fix the ulnar nerve with left thumb and index finger, stab into the skin and subcutaneous tissue with No.5 needle and advance parallel to the ulnar nerve toward the heart, stop the needle when there is a radiating foreign sensation to the little finger, draw back no blood, inject 1~2ml of drug, and withdraw the needle by dragging injection method to fill the elbow canal with drug. Wrist joint cavity puncture method Yangchi point into the needle point operation method: the patient extends the forearm prone palm, in the dorsal transverse wrist horizontal line, between the total extensor tendon ruler and the little finger extensor tendon, for the needle point. Before entering the needle, extend the finger dorsally and feel the movement of the common extensor tendon at the dorsal transverse wrist line, and feel the depression on the ulnar side of the common extensor tendon to help locate it. The skin is routinely disinfected, and a No. 5 needle is used to penetrate the skin and subcutaneous tissue vertically, passing between the common extensor tendon and the extensor tendon of the little finger and reaching the joint bone suture, with the tip of the needle entering the joint cavity. After aspiration without fluid accumulation, 3 ml of medicinal solution was injected.