For patients whose joint pain does not improve with medication or physical therapy, “joint grease” injections may provide temporary relief. The joint is injected with a joint fluid supplement that acts as a lubricant for the damaged joint. Joint injection schedules and duration of relief vary according to the treatment chosen and the individual patient. However, these injections do not cure the diseased joint and joint replacement may be needed as the joint worsens with time.
Depending on the type of injury or pain your are experiencing different types of injections may be chosen. For some joints, injecting fluid into the joint can help to restore lubrication in the joint. In other cases a steroid may be injected to reduce pain or inflamation.
Joints normally have a fluid (called synovial fluid) that acts as a shock absorber. When the synovial fluid thins and loses its elasticity, the cartilage of the joint can wear down causing osteoarthritis pain. Viscosupplementation is designed to mimic the shock absorbing quality of healthy synovial fluid in the knee joints. This involves a preparation of Hyaluronic acid that is injected directly into the knee joint. Hyaluronic acid is a naturally occurring substance found in joint fluid.
Viscosupplementation has been shown to relieve pain in patients who did not get relief from other non surgical measures of treatment. This has been around in Europe and Asia for several years. The U.S. FDA approved it for use in 1997.
Here in the U.S. it is currently only approved for use in the knee, although other joints trial have been ongoing. Two preparations of Hyaluronic acid are available, a natural product made from rooster combs ( Synvisc) and an artificial one made from bacterial culture’s (Euflexxa) If you are allergic to egg or poultry products or have had a reaction with previous injections, the manufactured product should be used. Your Physiscian can help you make that decision.
Intra-articular corticosteroid injections ( cortisone) are given to reduce moderate to severe pain. They can provide quick pain relief and reduce inflammation which in turn could help improve the muscle functiion. However, the effects are not long lasting, possibly up to two months only. Typically no more than three or four injections should be given in a joint in a year. There is also the potential for long term joint damage with frequent repeated injections over a long period of time. Knees, shoulders, hips, ankles and elbows can be injected.
Some injections require a visit to the hospital, where the injection is performed by radiology using fluroscopy to visualize the joint. The shoulder and hip injections to the subacromial space are performed using this technique.
Other injections can be performed in the office. These include injecting steroid into the hip trochanter bursa, the ankle joint, wrist tendons and elbow’s for tendonitis ( tennis elbow).
Recovering from an Injection
Patients are able to return to their usual activity after the procedure, however aggressive exercise should be avoided for 24 hours after the injection.
Physical therapy is sometimes used as an adjunct to the treatment.
When the shots work they can provide relief for several months.
It is possible to repeat the injections if your physician feels you may benefit from a repeat course.
There is no proof that viscosupplementation injections will reverse the progression of osteoarthritis however it may play a role in delaying Total knee Surgery.