Joint
Wrist
Thumb MCP joint
Shoulder
Elbow
Hip
Knee
Ankle
Side
Right
Left
Indication
Steroid Preparation
Methylprednisolone acetate (Depo-Medrone) 40mg/ml
Triamcinolone acetonide (Kenalog) 40mg/ml
Steroid Volume (ml)
Batch Number
Local Anaesthetic
1% Lidocaine
0.5% Bupivacaine
0.25% Bupivacaine
Anaesthetic Volume (ml)
Safety Checks
Anticoagulation reviewed
Allergies checked
Infection / skin integrity checked
Consent obtained
Procedure tolerated well
Safety netting/Post-procedure advice given
Additional Notes (optional)
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