FAQs on Joint Injections in Nashville

Joint injections are effective treatments for the symptoms associated with arthritis. Whether you have osteoarthritis (OA), rheumatoid arthritis (RA), bursitis, or gout, an injection will reduce swelling, improve joint mobility, and alleviate pain.

Who is a candidate for a joint injection?

Joint injections work best for patients with localized swelling and pain, which means only one joint is affected. If you have multi-joint pain, this is not the best treatment option. Patients who need joint injections include those with arthritis and anyone with a complication from a previous joint injury.

Why are joint injections done?

Joint injections should not take the place of standard arthritis treatment. However, this is a part of your overall arthritis plan of care, which includes oral medications, rest, heat/ice therapy, splints, and physical therapy. When conservative measures do not alleviate the pain and symptoms, the pain management specialist may recommend a joint injection.

What are the types of joint injections?

The two main types of joint injections are corticosteroid injections and hyaluronic acid injections. The type chosen for you will depend on the kind of arthritis you have, how the arthritis affects you, and the joint that is affected.

Corticosteroids are potent inflammation-reducing medicines. These drugs are best when inflammation is the source of joint pain. Hyaluronic acid injections are used to replace lost synovial fluid in the joint. Injecting synthetic synovial fluid into the joint improves movement and reduces pain. Examples include Hyalgan, Orthovisc, and Synvisc.

How should I prepare for the joint injection?

Before the injection, be sure to discuss all your medications with the doctor. Because bleeding is a risk, blood-thinning agents are held several days before the procedure. In addition, diabetic patients must have blood sugar levels under control prior to the injection. For people with a previous joint replacement or those who suffer from osteoporosis, corticosteroid injections are contraindicated.

How is the joint injection performed?

Both hyaluronic acid injection and corticosteroid injection are performed the same way. The doctor cleanses the skin with an antiseptic solution after feeling the joint to identify the injection site. Using ultrasound guidance, the doctor inserts a needle into the joint space and instills the medication. If necessary, the doctor may aspirate excess fluid from the joint prior to injecting the medication. Once the needle is removed, a small bandage is applied, which you can remove the next day.

What are the side effects and risks of joint injections?

Possible side effects of hyaluronic acid injections include joint swelling and post-injection pain. Side effects of corticosteroid injections include facial flushing, discoloration and thinning of the skin at the injection site, weight gain, and trouble sleeping. Risks and complications of both injections include infection, bleeding, nerve damage, and blood vessel injury.

Are hyaluronic joint injections effective?

In a recent large Cochrane review of hyaluronic acid injections for knee pain, researchers found that this treatment relieves OA knee pain better than nonsteroidal anti-inflammatory drugs (NSAIDs), with fewer side effects. In one large study involving more than 4,500 patients with knee arthritis, patients receiving hyaluronic acid injections reported improved functional ability and significant pain relief.

Do corticosteroid joint injections work?

According to a large Cochrane review, intra-articular corticosteroid injections were found to be more effective than placebo for pain relief. In this study, the effects lasted for up to 24 weeks.

Resources

Bellamy N, Campbell J, Robinson V et al. (2006). Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev, 19: CD005328.

Lambert RGW, Hutchings EJ, Grace MGA, Jhangri GS, Conner-Spady B, & Maksymowych WP (2007). Steroid injection for osteoarthritis of the hip. A randomized, double-blind, placebo-controlled trial. Arthritis Rheum, 56(7):2278–87. doi: 10.1002/art.22739.

Miller LE & Block JE (2013). US-approved intra-articular hyaluronic acid injections are safe and effective in patients with knee osteoarthritis: Systematic review and meta-analysis of randomized, saline-controlled trials. Clin Med Insights Arthritis Mus Disorders, 6, 57-63. doi:  10.4137/CMAMD.S12743