What Are Joint Injections?A joint injection is a common treatment method that is performed to manage stiffness and pain that arises in the joints due to inflammation. Chronic joint pain and even acute pain that is intense may cause mobility problems that can disrupt an individual’s daily routine and decrease that person’s quality of life. If the symptoms are not properly treated, they can eventually start to have detrimental effects on emotional and mental health as well.
Several types of joint injections have been established for the purpose of pain management. A typical joint injection usually consists of a combination of a corticosteroid and an anesthetic that target both pain and inflammation.
However, additional injection procedures include:
- An injection of hyaluronic acid, which effectively cushions and lubricates the damaged joint.
- An injection of platelet rich plasma (PRP), which is a procedure where a patient’s blood plasma is collected, fortified with platelets that promote healing, and then re-injected into the affected joint.
Commonly Injected JointsThere are a number of joints that are commonly treated through different types of injections, these include: facet joints, the sacroiliac joint, the ankles, shoulders, and the knees.
Facet joints, also known as zygapophyseal joints, refer to small bony structures located between the vertebrae of the spine that promote spinal stability. In particular, facet joints resemble bony knobs that connect spinal vertebrae in a chain-like manner in order to allow the spine to move in a variety of different ways. Except for the vertebrae that are located at the top and bottom of the spine, each vertebra is connected to the one above as well as below it, by facet joints.
In addition, a protective layer of cartilage that is rubbery and smooth covers the facet joints. The cartilage prevents the development of friction when the vertebrae rub against each other. Each joint is encased in a capsule that provides lubrication and improves the mobility of the spinal vertebrae. Furthermore, there are internal and external nerve roots that originate in the spinal cord, travel through tunnel-like spaces near the facet joints, and into various areas of the body including the neck, extremities, and the organs. Although the facet joints promote stability and mobility, they also enable the spine to twist, bend, and stretch.
Facet joint pain, also referred to as facet joint syndrome, is a condition that frequently requires pain management treatment. It typically develops due to the degeneration or damage of one or more facet joints. A neck or back injury and arthritis are additional health problems that may result in facet joint inflammation or the pain that originates in the area where the damaged joint is located.
Steroid injections are often recommended for diagnostic purposes before a treatment approach for facet joint pain is suggested, in order to determine if the patient is really suffering from an inflamed facet joint. The injection entails administering an anesthetic and a steroid into the back near the area where the physician believes the affected facet joint is located. If a patient undergoes the injection and experiences pain relief directly after the procedure, it will be repeated in order to confirm how effective the injection was. If two steroid injections are performed successfully at the targeted area this is an indication that the patient does have facet joint syndrome. However, if the injections are ineffective, additional diagnostic examinations may become necessary to properly assess the underlying cause of the pain.
The sacroiliac joint is a structure that is located at the bottom of the spine, and connects the spine to hips. The purpose of this joint is to help the spine bear the weight of the upper region of the body. The sacroiliac joint also decreases the incidence of injuries by improving overall stability and restricting the torso’s range of movement. Furthermore, the sacroiliac joint connects the ileum, known as the pelvic bone, to the bottom of the spine, which is called the sacrum. This structure is also referred to as the diarthrodial joint.
Thin layers of cartilage prevent friction from developing between the ileum and the sacrum. In addition, between these two structures sits a small space that is filled with clear, thick synovial fluid that lubricates both joints, and a fibrous capsule encases this entire portion of the lower spine. The capsule is protected by a sturdy membrane, and the region that surrounds this membrane is the area into which a joint injection is administered.
A sacroiliac joint injection is typically performed to decrease persistent back pain that developed due to an injured or inflamed sacroiliac joint. Reports have repeatedly shown that a large number of adults suffer from nonspecific, persistent lower back pain that is the result of sacroiliac joint issues. Clinical research has also consistently demonstrated that steroid injections are especially effective at reducing sacroiliac joint pain.
Specific injection procedures that may be performed include an extraarticular injection into to the tissue that surrounds the joint or a periarticular injection that is administered directly into the joint. Many patients report that the pain relieving effects of sacroiliac joint injections last for up to one month and that receiving several injections usually extends the period of pain relief.
Ankle injections entail administering a combination of medication directly into the ankle joint as well as the surrounding soft tissue. An anesthetic and a corticosteroid are typically used for the injection. Persistent ankle pain may develop due to a blunt force injury that causes the tissue to become damaged and inflamed, or certain conditions such as arthritis, bursitis, tarsal tunnel syndrome, or gout. An ankle injection is usually suggested after conventional forms of treatment such as over-the-counter medicine (e.g., ibuprofen, aspirin) have proven to be ineffective at reducing the pain. In addition, a minimally invasive injection may be recommended if the ankle pain is beginning to cause serious mobility issues, tenderness, swelling, popping or cracking sounds upon movement, or a deformity. Before an invasive treatment method such as surgery is recommended, ankle injections are suggested.
Elderly individuals as well as athletes who have a history of ankle injuries tend to develop arthritis in this joint. However, clinical reports indicate that ankle injections usually provide dramatic relief for arthritis patients. Tarsal tunnel syndrome is a condition in which the tibial nerve in the ankle becomes compressed. Both tarsal tunnel syndrome and arthritis may cause symptoms that include tingling, burning, pricking, and pain that worsens when weight is placed on the ankle. Physicians generally discuss ankle injections as a treatment option with patients who received physical therapy or took pain relievers, but did not experience significant relief. Ankle injections typically improve mobility and reduce pain for the majority of patients who suffer from tarsal tunnel syndrome, bursitis, or gout.
Shoulder pain often develops as a result of damage or inflammation of musculoskeletal tissue, nerves, or blood vessels. The shoulder consists of the collarbone, also referred to as the clavicle, the scapula, commonly known as the shoulder blade, and the upper arm bone, which is called the humerus. Its complex structure makes this joint especially susceptible to damage, although it generally has a large range of mobility. Out of the all of the musculoskeletal problems that are typically reported, shoulder pain is the second most common complaint.
An intraarticular peripheral injection may be recommended for shoulder pain that has become chronic. This type of injection aims at reducing pain in the shoulder by targeting inflamed nerves. An alternative treatment method is a platelet rich plasma therapy injection, which effectively provides pain relief without causing serious adverse effects. Some patients do not experience any side effects after undergoing this procedure.
The knee joint is one of the most common areas of the body to sustain damage or injury, and is often treated through knee joint injections. Physicians often suggest different forms of knee injections according to the severity and underlying cause of the pain. Knee joint injections will be the focus for the remainder of this guide.
There are four bones that make up the knee joint, known as the fibula, tibia, patella, and femur. The bones function as one structure in order to enable smooth movements. In addition, several muscles, including the quadriceps and hamstrings, promote knee flexion and knee extension. The quadriceps are supportive muscles for the frontal portion of the knee and the hamstrings support the posterior portion of the knee. Ligaments and cartilage help steady the knee joint as well. Moreover, the ACL, known as the anterior cruciate ligament and the PCL, known as the posterior cruciate ligament, are important ligaments positioned in the central region of the knee, that enable the joint to rotate. The medial and lateral meniscus are cartilage that cushion, protect, and prevent the tibia and femur from rubbing together.
Damage or injury to any of the structures that make up the knee may lead to throbbing pain or inflammation that can become chronic. For example, twisting the knee in abnormally rapid manner during vigorous activities such as sporting events can lead to an injured tendon. The gradual wear and tear of cartilage in the knee, also referred to as degeneration, may result in pain and swelling as well. Physicians generally inquire about a patient’s medical history to determine if a known incident led to the onset of the pain or if the knee has been previously injured. Imaging screenings may also be performed in order to help the physician properly diagnose the source of the pain and determine which type of knee joint injection will be most appropriate.
How Is A Knee Joint Injection Performed?The preparation for a knee injection procedure entails the sterilization of the site where the medication will be injected to reduce the risk of complications such as an infection. Next, local anesthesia is applied directly to the skin and then a corticosteroid is typically injected into the knee near the affected region. This is the most common form of knee injection and the effectiveness of corticosteroid injections for chronic pain has been extensively studied. One large-scale review of clinical trials, in particular, showed that knee joint corticosteroid injections provide dramatic pain relief.
If a platelet rich plasma injection will be performed, blood is initially drawn from the patient before the procedure begins. The blood that is collected is placed in a centrifuge in order to separate the blood from the plasma. Plasma contains high levels of platelets, which has been shown to promote healing. The plasma solution is injected into the affected knee. The physician uses an imaging technique such as fluoroscopy during the placement of the needle as well as when the plasma is being injected to ensure that it is delivered to the targeted region.
Research has also consistently shown that hyaluronic acid injections are effective at improving resistant knee pain by lubricating the joint and restoring its ability to move smoothly. One particular study indicated that patients who receive hyaluronic acid injections for osteoarthritis-induced knee pain typically report experiencing positive therapeutic results.
Although each of the knee joint injections that have been discussed are non-invasive and safe, a few complications and side effects may develop such as bleeding, bruising, facial flushing, nerve damage, an infection, or an allergic reaction to the medication.
Conditions Related To Knee Joint InjectionsOsteoarthritis affects over 20 million adults in the United States and osteoarthritic knee pain is the most common complaint. Furthermore, more than 50% of elderly individuals over the age of 65 suffer from arthritis. In addition to osteoarthritis and arthritis, cartilage tears, bursitis, tendonitis, and gout may lead to chronic knee pain. Knee joint injections have proven to be effective at improving the symptoms of each of these conditions.
ConclusionJoint injections are a common form of treatment for different types of joint pain and especially for complications from knee problems. The injection procedures have been well-established and studied extensively. As a result, clinical trials have demonstrated that joint injections are minimally invasive and safe techniques that even help some individuals avoid having to undergo surgery. Patients whose joint injections are successful typically report a dramatic reduction of pain as well as the ability to return to their daily activities. This treatment option is especially useful because it is an outpatient procedure that can be quickly performed.
- Manchkanti L, Pampati V, Fellows B, et al. Prevalence of facet joint pain in chronic low back pain. Pain Physician 1999;2:59-64.
- Boswell MV, Colson JD, Sehgal N, Dunbar EE, Epter R. A systematic review of therapeutic facet joint interventions in chronic spinal pain. Pain Physician. 2007;10:229–253.
- Stone JA, Bartynski WS. Treatment of facet and sacroiliac joint arthropathy: steroid injections and radiofrequency ablation. Tech Vasc Interv Radiol. 2009;12:22-32.
- 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.
- Cohen SP, Chen Y, Neufeld NJ. Sacroiliac joint pain: A comprehensive review of epidemiology, diagnosis and treatment. Expert Rev Neurother. 2013;13(1):99-116.
- Jee H, Lee JH, Park KD, Ahn J, Park Y. Ultrasound-guided versus fluoroscopy-guided sacroiliac joint intra-articular injections in the non-inflammatory sacroiliac joint dysfunction: A prospective, randomized, and single blinded study. Arch Phys Med Rehabil. 2013;9.
- Cardone DA, Tallia AF. Joint and soft tissue injection. Am Fam Physician. 2002;66:283-288.
- Tallia AF, Cardone DA. Diagnostic and therapeutic injection of the ankle and foot. Am Fam Physician. 2003;68(7):1356-1362.
- Khoury NJ, el-Khoury GY, Saltzman CL, Brandser EA. Intraarticular foot and ankle injections to identify source of pain before arthrodesis. AJR Am J Roentgenol. 1996;167:669–73.
- Kon E, Buda R, Filardo G, Martino A, Timoncini A, et al. Platelet-rich plasma: intra-articular injections produced favorable results on degenerative cartilage lesions. Knee Surg Sports Traumatol Arthrosc. 2010;18:472-479.
- Leung A, Liew D, Lim J, Page, C, Boukris-Sayag V, et al. The effect of joint aspiration and corticosteroid injections in osteoarthritis of the knee. Int J Rheum Dis. 2011;14:384-389.
- Lockman, L. Knee joint injections and aspirations. Can Fam Physician. 2006;53(11):1403-1404.
- McGarry J, Daruwalla Z. The efficacy, accuracy and complications of corticosteroid injections if the knee joint. Knee Surg Sports Traumatol Arthosc. 2011;19:1649-1654.
- Sampson, S, Reed N, Silvers H, Meng M, Mandelbaum B. Injection of platelet-rich plasma in patients with primary and secondary knee osteoarthritis: a pilot study. Am J Phys Med Rehabil. 2010;89(12):961-969.