Arthrogram (Joint Injection) Log
Please tell us your experience of discomfort after your joint injection. Your input will help us better understand the effects
of the procedure and of the medications we inject. When you are done, please mail, fax, or scan/email it back to us c/o:
Kim Eastman, OHSU Dept. of Diagnostic Radiology
Mail Code L-340
3181 SW Sam Jackson Park Rd.
Portland, OR 97239-3098
Fax (503) 494-4982
eastmank@ohsu.edu
Date:
Patient info:
We greatly appreciate your participation. Thank you so much!
Your Musculoskeletal Radiologists
OHSU Department of Diagnostic Radiology
No pain
Worst pain
imaginable
Please mark with an “X”
your pain level from 0 to 10:
1 day after injection:
2 days:
3 days:
4 days:
5 days:
6 days:
7 days:
To be answered at 7 days:
How painful do you remember the injection itself
being?
Additional Comments:__________________________________________________________________________________
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