Joint Injections

Providers at Phoenix Family Medical Clinic use injection of joints, bursae, tendon sheaths, and soft tissues of the human body a useful diagnostic and therapeutic skill. Our providers use Trigger Point and Joint Injection for treatment of common pain symptoms of the neck, shoulder, wrist, hand and other lower limbs. A lidocaine injection into the subacromial space can help in the diagnosis of shoulder impingement syndromes, and the injection of corticosteroids into the subacromial space can be a useful therapeutic technique for subacromial impingement syndromes and rotator cuff tendinopathies. Evidence-based reviews of joint and soft tissue injection procedures have found few studies that support or refute the efficacy of common joint interventions in medical practice. However, substantial our practice-based experience supports the effectiveness of joint and soft tissue injection for many common problems.

These injections are most useful in instances of joint or tissue injury and inflammation. History of pain, local and referred, will provide important clues to the underlying pathology. Physical examination is extremely helpful in ascertaining the diagnosis. Our providers observe the patient's response to previous injection in deciding whether and when to proceed with reinjection. Most patients, if they are going to respond, will respond after the first injection. If the patient has achieved significant benefit after the first injection, an argument can be made to give a second injection if symptoms recur. However, patients who have gained no symptom relief or functional improvement after two injections should probably not have any additional injections, because a subsequent positive outcome is low.

Local Anesthetics

Before injection of a joint or soft tissue, a small quantity of 1 percent lidocaine is injected subcutaneously with a 25- to 30-gauge needle to provide local anesthesia. For the actual joint or soft tissue injection, most physicians mix an anesthetic with the corticosteroid preparation. This provides temporary analgesia, confirms the delivery of medication to the appropriate target, and dilutes the crystalline suspension so that it is better diffused within the injected region.

Intra-articular steroid injections have produced clinically and statistically significant reduction in osteoarthritic knee pain 1 week after injection. In a meta-analysis, Arroll determined that evidence supports short-term (up to 2 weeks) improvement in symptoms of osteoarthritis of the knee after intra-articular corticosteroid injection. The beneficial effect has been found to last for 3 to 4 weeks. Local corticosteroid injection as treatment for flexor tenosynovitis was found to be 90% effective in relieving symptoms, and serious adverse effects were avoided if guidelines were followed.

How Do Knee Osteoarthritis Injections Work?

Normal joint fluid contains a substance called hyaluronan. It acts like a shock absorber and lubricant in your joint and is needed to help the joint work properly. Hyaluronan is highly viscous, allowing the cartilage surfaces of the bones to glide upon each other smoothly. This leads to decreased symptoms of osteoarthritis.

Benefits of Joint Injections:

• Steroid injections, such as cortisone, reduce swelling and ease pain in the joint. The knee can flex more normally. Activity which would have caused pain or been impossible before the injection can be resumed.
• An injection of a bio-lubricant can increase flexibility and reduce pain caused by osteoarthritis. The bones are lubricated so there is less grating on each other.
• One of the major benefits of injections in the knee are that they can decrease or eliminate the need for surgery.