Injections of anaesthetic and/or steroids into the joint can be an effective form of pain relief for people with chronic joint pain or musculoskeletal injuries. They can also be used to remove excess fluids, for example from cysts and ganglions.
Why am I being offered injections rather than surgery?
You may be offered therapeutic injections in the first instance rather than surgery if you have osteoarthritis or other inflammatory conditions such as tendonitis or gout. This is because all surgery, no matter how safe and effective, carries some small risks.
Surgery is an invasive procedure that involves making incisions into your skin, which can introduce infection or cause bleeding or nerve damage. In some cases, people may have an adverse reaction to the anaesthetic. For this reason, your doctor will normally recommend trying minimally-invasive procedures first.
Types of therapeutic injections
Ultrasound scans are used to examine the joint and guide the needle into the correct position. Using ultrasound ensures accuracy levels of 90-100% as the doctor can see the needle on a monitor. Without it, the positioning of the needle is likely to be 63-79% accurate.
The site to be injected will be numbed with local anaesthetic before the needle is inserted and gently advanced into the right position. You may be given:
- An injection of corticosteroids to reduce the pain of arthritis or inflammation. There may be some worsening of the pain initially but this should subside within 24-48 hours.
- Dry needling, which involves repeatedly injecting an abnormal tendon using ultrasound to guide the needle. This creates mild trauma in the tendon and causes localised bleeding. The growth factors and proteins in blood are believed to promote cellular regeneration, helping the tendon to heal. The full effects of this procedure can take weeks or even months so you will not experience the rapid relief provided by steroid injection.
- Hyaluronic acid injections are used to help lubricate joints and provide temporary relief from pain. Hyaluronic acid is a synthetic compound that is chemically similar to natural joint fluid. When injected into damaged joints, it helps to lubricate them and act as a shock absorber. The beneficial effects of this type of injection are normally felt within days and last a few months. Your doctor may recommend a course of injections.
Benefits of therapeutic injections
Therapeutic injections are quick to administer (normally taking around 25 minutes), the relief from pain can be rapid and it may last for several weeks or months. Anaesthetic helps to block pain impulses in the short-term while steroids reduce inflammation, providing a longer-term relief from pain. You should continue to do exercises recommended by a physiotherapist to maintain joint flexibility and movement.
Areas that might be treated using therapeutic injections include: wrist, elbow, shoulder, hip, sacroiliac joint, knee, ankle and foot. Often, therapeutic injections provide sufficient pain relief to enable you to postpone or even avoid surgery altogether.
However, over time the injections may become less effective at which point your doctor will discuss other options with you.
Difference between diagnostic and therapeutic injections
There are two types of joint injections – diagnostic and therapeutic.
Diagnostic injections are used to diagnose diseases, abnormalities and injuries that are leading to chronic joint pain.
By injecting dye and anaesthetic into the joint it is possible to pinpoint where the pain is coming from. This procedure may also be used during arthroscopic (or keyhole) surgery so that the surgeon can see precisely where repairs need to be made.
W27 Diagnostics & Imaging are able to provide assistance with both diagnostic and therapeutic injections. Contact us today to find out more.