Injections may be used to reduce pain and improve function in patients suffering from joint pain. Commonly used injectable medications are cortisone, hyaluronic acid and autologous conditioned plasma.
Cortisone is used to reduce inflammation in joints (arthritis) and around tendons (tendonitis) and tendon sacs (bursitis).
Arthritis damages the smooth lining of the joint called cartilage. This causes friction in the joint leading to pain and stiffness.
Tendonitis is inflammation of the tendon (attaches muscle to bone) which causes pain, swelling and loss of function.
Bursitis is inflammation of the bursa (fluid filled sacs between tendon and bone) which causes pain, swelling and loss of function.
Hyaluronic acid is a component of the normal joint lubricating fluid called synovial fluid. Hyaluronic acid injections increase joint lubrication to reduce friction and thereby relieve pain and stiffness of arthritis.
Autologous conditioned plasma is obtained from the patient’s own blood. A centrifuge is used to separate the blood into a plasma component that contains proteins, platelets and growth factors and a cellular component that is discarded. The plasma component is injected into joints and around tendons and tendon to promote a healing response.
How are the injections carried out?
The injections are carried out in Dr. Chandrasekaran’s rooms. The procedure takes 15 to 20 mins. The cortisone injection is mixed with local anaesthetic, the hyaluronic acid injection comes in a prefabricated syringe and the autologous conditioned plasma requires blood to be taken from the arm and separation of the plasma component using a centrifuge and a specialised syringe delivery system. An ultrasound is used to guide the injection into the joint or tendon space. A dressing (the size of a bandaid) is used to cover the injection site which can then removed the following day. Driving and normal activity can be resumed after the injection but strenuous exercise should be avoided for 48 hours
What are the unwanted effects of injections?
Injections are generally very safe. Unwanted effects include:
- A transient increase in pain that may last up to 72 hours
- Infection may develops 2-3 days following the injection and presents as fevers, chills, joint swelling, redness, reduced movement and inability to weight bear. If these symptoms develop it is important that you present for urgent medical review
- Tendon rupture may occur with repeated corticosteroid injections. For this reason repeat cortisone injections are given with 4 month intervals
- Limited effect of the injection. In general 70% of patients report a reduction in pain following an injection. The effect of the injection is dependent on the severity of the disease, age and co-morbidities. If one type of injection is not effective then another type is often trialled. There is no conclusive evidence of the superiority of one type of treatment over another
- There is no conclusive evidence that injections increase subsequent risk of infection after surgery. However, there is usually a 6 week time lag between the injection and planned surgery