Joint Efforts: A Review of Large Joint and Bursa Steroid Injections and Aspirations by Primary Care Physicians

Large joint and bursa steroid injections and aspirations are useful for many musculoskeletal pathologies commonly seen in primary care. However, there is lack of clarity on whether primary care physicians should perform these procedures themselves or refer to specialists. This study reviews the existing literature to explore the impact of primary care physicians performing these procedures. We performed a PubMed search using two search protocols to identify relevant articles. Two investigators independently screened articles for relevance via specific inclusion and exclusion criteria. Two additional investigators resolved disagreements. We also hand-searched references in all articles. The search methods identified 257 articles, of which 132 met inclusion criteria. Agreement was almost perfect for results from Protocol 1 (kappa = 0.96, 95% CI 0.91-0.99) and substantial for Protocol 2 (kappa = 0.77, 95% CI 0.60-0.94). The results reveal data on primary care physicians performing large joint and bursa steroid injections and aspirations including current trends, management and procedural techniques, outcomes, safety and complication rates, patients' access to treatments, cost differences between primary care versus subspecialty performed procedures, feasibility concerns, training, and patients' perspectives. We conclude there is a benefit to primary care physicians performing these procedures with regards to cost, access, and patient satisfaction with no compromise to outcomes, safety, and complication rates.