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Rheumatology Advance Access published online on May 11, 2005
Rheumatology, doi:10.1093/rheumatology/keh683
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© The Author 2005. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org
Received October 4, 2004
Accepted April 12, 2005

Concise Report

Joint and soft tissue injections: a survey of general practitioners

W. G. Liddell 1*, C. R. Carmichael 1, and N. J. McHugh 1

1 Research & Clinical Effectiveness Unit, Royal National Hospital for Rheumatic Diseases, Upper Borough Walls, Bath BA1 1RL, UK

* To whom correspondence should be addressed.
W. G. Liddell, E-mail: william.liddell{at}rnhrd-tr.swest.nhs.uk


  Abstract

Objectives. To determine the type of joint and soft tissue injections carried out by general practitioners (GPs) in the Bath area and factors affecting activity.

Methods. A questionnaire was sent to 360 GPs requesting information on injections carried out during the previous 12 months, referral pathways for injection, barriers to injecting and training.

Results. We received 251 replies. The commonest injections were for tennis elbow, glenohumeral joint, knee, supraspinatus tendonitis and carpal tunnel. The majority of GPs (66.4%) carry out most injections themselves, 26.3% refer to a colleague and 7.3% refer to secondary care. Over half (51%) of all the injections are carried out by 15.6% of the GPs. Factors associated with higher levels of injection activity were: male gender, partnership, more than 10 years’ experience, a special interest in rheumatology or orthopaedics and working in a rural or mixed practice. The most important barriers to carrying out injections were lack of practical training, lack of confidence and inability to maintain skills. Most GPs have been trained on models.

Conclusions. Most GPs carry out some joint and soft tissue injections, but limit themselves to knees, shoulders and elbows. A small highly active group receive referrals from colleagues. Gender and specialist training strongly influence activity. Many, especially female and part-time, GPs find it hard to maintain their skills and confidence. Training targeted at this group, based in practices and using models and other tools, is likely to increase the number of patients receiving timely injections in general practice.

Keywords: Joint injection; Primary care; General practice; Rheumatology; Musculoskeletal medicine.
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