Dr. Margaret L. Meredith, D.P.M.
Total Foot Care of the New River Valley
312 North Main St.
Pearisburg, VA 24134
Phone (540) 553-4300
Fax (540) 921-2149
Injection / Aspiration Consent
Patient Name:_______________________________________________ DOB:_____________
___________ Soft Tissue Injection Is a shot with a needle into a soft tissue space such as between a
muscle, tendon, bursae, or plantar fascia. Pain relievers, such as lidocaine, and anti-inflammatory
medicine, such as corticosteroids are most often used in an injection.
___________ Joint Injection Is a shot with a needle into a joint. Doctors can use a needle to put in the
medicine. Pain relievers, such as lidocaine and anti-inflammatory medicines, such as corticosteroids are
the medicines most often used in an injection. The shot is used to decrease inflammation and swelling in
the inflamed joints.
___________ Ganglion cyst aspiration and/ or injection is when a needle is used to draw fluid out of a
ganglion cyst to relief pressure, and then medicine can be injected into the cyst area to help reduce pain
and swelling. Medicines like lidocaine for pain relief and corticosteroids are most often used.
___________ Aspiration / Arthrocentesis is when a needle is used to withdraw a fluid out of a joint.
This procedure is done by cleaning off the skin with betadine or alcohol. A needle is then used to take out
any fluid in the joint. This is necessary to relief pressure in the joint, which will help the pain, and to also
get a better look at what is in fluid that has built up in the joint.
___________ Nerve Block Injection is a shot of alcohol solution (sclerotherapy) that may be used to
temporarily or permanently numb the nerve. The injection usually takes a few minutes to perform and
sometimes several treatments are needed.
While each of the procedures listed above have some risks associated with them, they are relatively safe.
Some of the risks associated with these procedures are:
 Pain for a short time at the site of the injection
 allergic reaction due to the medicines can occur
 The corticosteroid may cause an elevation in blood sugar in diabetic patients and raise blood
pressure
 Other side effects of the medication can be flushing in the face and chest, heart palpitations, and
hyperactivity.
 Muscle weakness and softening of bones, resulting in increased risk for fracture, hip
degeneration, poor wound healing, worsening of stomach ulcers, and decreased ability for the
body to fight infections
There is no guarantee that the procedure will totally relieve your pain but this procedure will give you a
reasonable chance of improving your pain.
By signing this consent, I acknowledge that I have read and understand and accept the potential risk and
benefits of the proposed procedure. I have had time to discuss with my physician and all questions have
been answered and I willingly would like to PROCEED WITH THE PROCEDURE.
Signature:______________________________________
Date:_______________________________