14 Jun Overview of Joint Injection Procedures
A joint injection is used to manage pain and stiffness in the joint that is due to inflammation. Chronic joint pain can cause mobility problems that disrupt a person’s daily routine and decrease the person’s overall quality of life. When symptoms persist after rest and medications, the orthopedic specialist will often consider a joint injection.
What are the common types of joint injections?
Several types of joint injections are used for pain management. These include:
- Corticosteroid and anesthetic injection – The doctor can inject the joint with an anti-inflammatory
agent that decreases inflammation. The anesthetic is added for immediate pain relief.
- Hyaluronic acid injection – This solution cushions and lubricates a wore and damaged joint.
- Platelet-rich plasma (PRP) injection – For this injection, the patient’s own blood is collected via venipuncture. The platelets are separated from other blood components in the laboratory. The platelets are then injected into the joint. They contain growth factors and other substances that promote joint healing.
- Stem cell injections – This procedure involves injecting the joint with stem cells, which are obtained from the bone marrow, adipose or possibly from amniotic fluid. These cells will help regenerate damaged and injured joint structures. While a fairly new treatment, stem cell injections are showing promise for joint pain.
What joints are commonly injected?
There are several joints that are often treated using injections. These include:
- Facet joints – The facet joints are the tiny joints along both sides of the spine. Also called zygapophyseal joints, these structures are located between each vertebra and offer spinal stability. Facet joints connect the vertebrae in a chain-like manner, and they contain a protective layer of cartilage. The cartilage prevents friction as the vertebrae glide against each other. Each joint also has a capsule that provides lubrication and mobility to the spine. Facet joint pain occurs from degeneration or damage to the joints. Injecting these joints with a steroidal agent, with or without an anesthetic, will help ease pain and improve mobility.
- Sacroiliac joints – On either side of the top buttock region are the sacroiliac joints. These structures connect the spine to the hips. The purpose of sacroiliac joints is to help the spine bear weight of the upper body region. Sacroiliac joints decrease the incidence of injuries by offering stability and restricting the trunk range of motion. Called the SI joints, these structures also have layers of cartilage that can erode away over time. SI joint injections of cortisone and lidocaine are used to improve movement and alleviate pain. A sacroiliac joint injection is often performed under fluoroscopy (x-ray guidance) to assure correct needle placement.
- Ankle joints – Ankle injections involve a combination of medication being injected into the joint and the surrounding soft tissue. An anesthetic and corticosteroid are usually used to alleviate pain and inflammation. Ankle injections are reserved for cases where over the counter medicines and prescription analgesics do not work. Elderly persons, athletes, and those with a history of ankle injuries often develop severe ankle arthritis.
- Shoulder joints – After damage from arthritis or trauma, the shoulder joint can become painful. Shoulder pain is the second most common musculoskeletal problem and complaint. The doctor will inject this joint under real-time x-ray. Solutions used are usually bupivacaine and cortisone, which alleviates pain and reduces inflammation.
- Knee joints – The knee joints are the most commonly injured joint of the body. Joint injections with hyaluronic acid or PRP therapy are often given in a series of three spaced 3-6 weeks apart. The doctor will inject the joint using sterile technique, which improves mobility and alleviates pain.
Chou R, Atlas SJ, Stanos SP, Rosenquist RW. Nonsurgical interventional therapies for low back pain: A review of the evidence for an American Pain Society Clinical Practice Guideline. Spine. 2009;34(10):1078-1093.