It starts small — just a twinge in your knee as you climb the stairs, a little weakness when picking up the laundry basket, or a dull, consistent pain during your morning run. But left untreated, pain can grow and cause major interruptions throughout your day.
Getting treatment might seem like a scary idea if you think an orthopedic surgery is just around the corner.
“Before turning to surgery, when possible, we want to try noninvasive procedures to see if we can resolve pain and other symptoms, and get patients back to activity faster,” said Derek Day, MD, a sports medicine physician with Avera Orthopedics in Sioux Falls, SD.
Noninvasive treatment includes orthopedic injections in tandem with physical therapy, which often yields effective results. It especially minimizes risks related to surgery, which can be more painful, cause scarring and extend recovery.
What are the overall benefits of orthopedic injections?
Orthopedic injections offer several key benefits, including relieving pain and reducing inflammation in affected joints or tissues. By targeting the source of discomfort directly, these injections can improve overall function and allow for smoother, more comfortable movement.
“When symptoms are addressed, patients feel empowered to perform normal activities and return to the things they love,” said Day.
What are common orthopedic injections to manage symptoms?
You might be surprised to learn how many types of injections are available based on your injury. Check with your orthopedic doctor and health insurance provider to learn about coverage.
Here’s a breakdown of some options and what’s best for certain types of injuries.
Corticosteroid Steroid Injections
- Used for joints
- Injected material: Potent anti-inflammatory medicine used alongside an anesthetic (a numbing agent)
- Conditions: Osteoarthritis of the shoulders, wrists, spine, hips, knees, ankles, feet; gout and pseudo-gout; rheumatoid arthritis
Hyaluronic Gel Injections
- Used for joints
- Injected material: Hyaluronic acid, a lubricating fluid
- Conditions: Mild to moderate osteoarthritis in the knee and shoulder
Platelet-Rich Plasma Injections
- Used for joints and tendons
- Injected material: Patient’s own platelets – blood is withdrawn and a centrifuge separates the platelets from the plasma; platelets are then reinjected
- Conditions: Knee osteoarthritis; plantar fasciitis; tendinopathy (overuse) – rotator cuff, tennis elbow, Achilles tendons and gluteal tendons; partial tendon tears
Bone Marrow Aspirate Concentrate Injections
- Used for joints, tendons and bones
- Injected material: Patient’s own bone marrow – marrow is withdrawn and a centrifuge concentrates the stromal cells before they’re reinjected
- Conditions: Joint osteoarthritis, avascular necrosis of the hip, bony edema, partial tendon tears
Microfragmented Adipose Tissue (MFAT) Injections
- Used for joints and tendons
- Injected material: Patient’s own fat – fat is withdrawn from the belly or flank via needle, processed to concentrate the stromal cells and then these cells are reinjected
- Conditions: Joint osteoarthritis, tendinopathy (overuse), partial tendon tears
Prolotherapy Injections
- Used for soft tissue and joints
- Injected material: Dextrose (sugar water) – injection causes an inflammatory response that triggers the body’s own healing mechanisms to strengthen tissue
- Conditions: Joint instability, Ehlers-Danlos syndromes (EDS)
Nerve Hydrodissection Injections
- Used for nerves
- Injected material: Dextrose, saline or steroid with a local anesthetic
- Conditions: Carpal tunnel, cubital tunnel syndrome, peroneal nerve (foot drop), pain with trapped or pinched nerves
Trigger Point Injections
- Used for soft tissue
- Injected material: Needle passes through muscle with local anesthetic
- Conditions: Chronically tight muscles in the back, neck and shoulders; spine issues; fibromyalgia
How long do joint and tissue injections last?
“Relief can last weeks, months or even close to a year,” said Day.
In general, corticosteroid shots can last three to four months, but because of associated risks, physicians hesitate to give these shots on a frequent basis. Hyaluronic gel injections last about six months, and can be repeated more frequently due to less risk. Other injections, such as those that are sourced from the patient’s own body, can last up to a year (or longer).
“It depends on the severity of your pain and the damage to the affected body part,” explained Day. Injection treatment is personalized to your situation, and multiple treatment options, such as physical therapy, might be used to enhance relief and outcomes.
Are there any symptoms associated with orthopedic injections?
“The injections are well-tolerated by most patients,” said Day. “However, as with any procedure, there can be some symptoms or risks.”
Side effects could include:
- Temporary pain, burning sensation or swelling at the injection site
- Mild bruising or redness at the injection site
- Pressure at the site after the injection
- Localized tissue atrophy from steroid injections
- Rise in blood sugar from steroid injections (risk for diabetic patients)
- Rare risk of pseudo-sepsis reaction after hyaluronic gel injection
- Rare risk of infection, accompanied by fever, chills, and swelling and redness at injection site
- Rare allergic reaction
What’s next if my prescribed injections don’t work?
When injections aren’t relieving pain, it can mean one of two things:
- The source of pain still needs to be uncovered. For example, unresolved knee pain might indicate the real source is coming from the hip or spine.
- The condition is so severe that it’s not responding to conservative treatment measures.
“Sometimes we will use an injection of anesthetic, the numbing agent, to help diagnose the source of pain,” said Day. “If you experience significant relief of your symptoms with an injection of anesthetic, then we have the right source of pain — the severity of the condition may just limit response to corticosteroid or other agents. If this is the case, your condition may require more advanced care.”
You and your doctor will discuss further treatment, such as arthroplasty (joint replacement), intensive physical therapy, or radiofrequency ablation (deactivating nerve cells).
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