Scott Robert Perry / SHUTTERSTOCK.COM
A 68-year-old male patient returns to the office for his scheduled bilateral knee injections for primary osteoarthritis. The patient rates the pain in his right knee at an 8 on a scale of 10, and the pain in his left knee at a 7. He was in the office a week before, but the practice could not obtain a preauthorization for the injection of the knees. The patient’s weight is 279 lbs., height is 5’8”, BMI is 42.42, and his temperature is 98.5ºF. Both knees are swollen, warm and tender to the touch. His knees flex to 45º. Preauthorization is obtained, and the risks and benefits of the injections are reviewed with the patient.
After cleansing the skin and administering a local anesthesia, the rheumatologist, using ultrasound guidance due to the patient’s BMI, injected the left knee with hyaluronan derivative, Gel-One. The rheumatologist then injected the right knee, again using ultrasound guidance. The image and recording of the injection sites are added to the patient’s medical chart.