Spine & Joint Injections
In Office Joint Injections
Peripheral intra-articular injections (also called joint injections) have been used successfully for decades for the treatment of chronic joint pain. Injections may be performed into joints for diagnostic reasons, to identify pain-generating structures. Most often, joint injections are done for therapeutic purposes into the knee, hip, shoulder, ankle and other joints, with months of relief usually resulting.
Peripheral joint injections have been performed primarily in the office setting, with the doctor using bony landmarks identification for needle placement. With new technology, doctors now utilize the ultrasound guidance method to facilitate proper needle placement. This is done to avoid the possibility of incorrect needle placement, and to ensure that the medication goes into the joint space.
Spine Injections
Back pain is an extremely common health problem, and it is documented as the leading cause of work absence throughout most of the world. As part of the 2010 Global Burden of Disease Study, researchers found that back pain was the most common musculoskeletal condition. Because millions of people are affected with back pain, image guided spinal injections are now common pain management procedures.
Fluoroscopy is a procedure that utilizes a special table, x-ray technology, and contrast media to view structures of the human body that normally do not show up with regular x-rays. For spinal injection procedures, you are positioned lying on your side or abdomen on the procedure table. The doctor will clean the injection site using an antiseptic and then the skin and deeper tissues are numbed using a local anesthetic. The x-ray tube device is positioned over the body, and the procedure needle is guided into the epidural space, facet joint, or sacroiliac joint (depending on the procedure). While viewing the tip of the needle and inside the body on screen, the doctor then injects the medication into the joint or epidural space. After the injection, the procedure needle is removed, and a small bandage is applied to the site.
What Peripheral Joints Can Be Injected?
The three most commonly injected joints are:
Knee Joints
These are the largest joints of the body, and they are subject to arthritic conditions, such as osteoarthritis and bursitis. The knee joint is easily accessible, as it is not a deep joint.
Shoulder Joints
Another commonly injected joint is the glenohumeral joint (shoulder), which is the most mobile joint of the body. The shoulder joint is a complex structure, and it is surrounded by many muscles, tendons, and ligaments.
Hip Joints
These are frequently prone to chronic pain related to arthritic changes and injury. The hip is a ball-and-socket joint located deep in the body. The hip joint capsule extends down the top of the thigh bone (femur neck). Certain nerves and vessels should be avoided when injected these joints (neurovascular femoral nerve-vein-artery bundle).
What Are The Common Types of Spinal Injections?
For back, neck, arm or leg pain, there are five common injections used. These include:
Epidural Steroid Injection (ESI)
This injection involves injecting an anesthetic and anti-inflammatory steroid into the epidural space, near the inflamed or compressed spinal nerve. This procedure is used to treat a nerve root that is inflamed such as from a herniated disc or spinal stenosis. It can help patients frequently avoid the need for neck or back surgery when suffering from sciatica or radiculopathy.
Selective Nerve Root Block (SNRB)
This procedure involves injecting around a select nerve that is causing the neck or back pain. The procedure needle is positioned near the nerve, and an anesthetic with steroid is instilled around the nerve. The procedure is performed either for therapeutic or diagnostic purposes.
Facet Joint Injection (FJI)
The facet joints are tiny joints on either side of the posterior spine. A FJI involves injecting a steroid into the joint, with or without an anesthetic. Facet joints are injected for diagnostic and therapeutic purposes.
Facet Rhizitomy (Radiofrequency Ablation)
This procedure involves inserting a special probe needle around the facet joint, and using radiofrequency energy to deaden tiny sensory nerves. This procedure offers long-term back pain relief that studies show averages fifteen months. A repeat injection can work very well if the pain returns.
Sacroiliac Joint Injection
These joints lie between the sacrum and ilium, which are pelvic bones. The two joints are located below the lumbar spine. The procedure needle is positioned into the joint, and an anesthetic and corticosteroid solution is inserted.
Medial Branch Block
This procedure involves placing numbing medicine and steroid around the facet joint and relieving pain while blocking the small sensory nerves. If pain relief from the procedure wears off, it can either be repeated or a radiofrequency ablation can be performed. A MBB procedure itself provides on average 3 months of relief!
Frequently Asked Questions
Are joint injections effective?
In recent clinical studies, researchers found that joint injections were successful for relieving chronic joint pain. In one study involving 148 painful joints, ultrasound guidance was used for the injections. The study found that the procedure was significantly less painful than without ultrasound guidance. Two weeks after injection, 75% of patients reported good pain relief. In another study, researchers noticed 50% less procedural pain when ultrasound guidance was used for injecting joints in arthritis patients.
Will the injection hurt?
Because a local anesthetic is given, you should not feel pain, only pressure. When the local numbing agent is injected, you will feel a slight pinching sensation. The anesthetic is also injected near nerves, so you will have an immediate relief of pain. Corticosteroids begins to work within 20-48 hours, and this pain relief last for weeks.
When will I notice pain relief?
Because an anesthetic is injected into the joint, most patients report immediate pain relief. However, the local agent wears off in 4-16 hours, and pain could return. It takes the corticosteroid 20-48 hours to begin working. The injection site will be slightly tender for a few hours, but patients may apply an ice pack to relieve pain. Most people enjoy 2-6 months of pain relief following a peripheral intra-articular injection.
Who should not have a joint injection?
Certain people cannot have peripheral joint injections. This includes persons who:
- Are pregnant
- Have a systemic infection
- Have a skin infection
- Are allergic to contrast dye
- Have blood clotting problems
How should I prepare for a procedure?
Before the procedure, you will meet with one of the All Star Pain Management providers to discuss your condition. They will take a medical history, perform a physical examination, and conduct some preliminary x-rays and diagnostic tests.
The doctor will inquire about your medications, and certain blood thinners are to be held for a few days (aspirin, Lovenox, Coumadin, Plavix). Because light sedation may be used, arrange to have someone drive you home. Wear loose-fitting clothing to the medical facility, and be sure to leave all jewelry and valuables at home.
Depending on the procedure, you may be advised not to eat or drink a certain amount of hours prior.
Our physicians are experts in the use of image guidance for your type of procedure. Image guidance improves the accuracy and effectiveness of injections to ensure the best possible outcomes for our patients
Resources
- Hoy D, March L, Brooks P, et al. (2011). The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis, 73, 968-974.
- Sibbitt WL, Peisajovich A, Michael AA, et al. Does sonographic needle guidance affect the clinical outcome of intraarticular injections? J. Rheumatol. 2009 Sep;36(9):1892-902.
All Star Pain Management and Regenerative Medicine proudly serves the Annapolis, Greater Baltimore and Washington D.C. areas.