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As part of the treatment for pain and inflammation, your provider may recommend injections.
The most commonly used injectable medication given in our office is a corticosteroid preparation (cortisone). For knee joints we also use Viscosupplementation (hyluronate injections).
These injections can provide lasting relief of your symptoms and are generally safe and well tolerated.
Cortisone shots are injections that may help relieve pain and inflammation in a specific area of your body. They are most commonly injected into joints such as your knee, shoulder, hip, elbow, ankle, spine and wrist. Cortisone can also be used around other areas such as tendons and ligaments. Even the small joints in your hands and feet might benefit from cortisone shots. The injections usually comprise a corticosteroid medication and a local anesthetic. Often, you can receive a cortisone shot at your doctor’s office. Because of potential side effects, the number of shots you can receive in one year generally is limited.
Cortisone is a powerful anti-inflammatory medication that can be used for a broad array of orthopedic conditions, such as bursitis, tendonitis, and arthritis. It can greatly reduce swelling, redness, inflammation, and pain.
Immediately after the injection, you may feel that your pain is improved. This is due to the local anesthetic (lidocaine) injected with the cortisone. This will last for a few hours. Your pain may return, and you may have a sore joint for a day or two. This is called a “cortisone flair” and is a result of the mechanical process of needle insertion and irritation from the steroid itself. You should start noticing pain relief the 3rd to 5th day after the injection.
If possible, it is best to rest the joint for 24 hours (minimize walking and no gym). Applying ice to the affected area for 20 minutes at a time will help reduce any soreness created from the injection. You can also take Tylenol (Acetaminophen) or Anti-inflammatory medications such as Advil or Aleve as long as there are not any restrictions.
Every patient is different, and the degree of improvement varies per patient. Symptoms may improve for weeks to months.
In a twelve-month period, we generally prefer to perform no more than three injections. This is because the medication injected is meant to last for several weeks to several months. If three injections have not helped you much, it is very unlikely that you will experience any further benefit from an increasing number of injections. Also, giving more injections will increase the likelihood of side effects from the steroids.
If you are diabetic, cortisone will raise your blood sugar. Please make healthy food choices and refrain from sweets and breads. Call the office if you have pain, swelling, or redness around the injection site lasting longer than 3 days.
Often called “gel shots”, another treatment option for knee arthritis pain is a procedure called viscosupplementation. In this procedure, a gel-like fluid called hyaluronic acid is injected into the knee joint.
Hyaluronic acid is a naturally occurring substance found in the synovial fluid surrounding joints. It acts as a lubricant to enable bones to move smoothly over each other and as a shock absorber for joint loads. People with osteoarthritis (OA) have a lower-than-normal concentration of hyaluronic acid in their joints.
The theory is that adding hyaluronic acid to the arthritic joint will facilitate movement and reduce pain. If you have tried all other nonsurgical treatment methods and your pain continues to limit your activities, viscosupplementation may be an option.
The effectiveness of viscosupplementation in treating arthritis is not clear. It has been proposed that viscosupplementation is most effective if the arthritis is in its early stages (mild to moderate), but more research is needed to support this. Research in viscosupplementation and its long-term effects continues.
This treatment generally involves a series of injections (3-4) given to you weekly. If the injections are effective they may be repeated after a period of time, usually 6 months.
Although some patients report relief of arthritis symptoms with viscosupplementation, the procedure has never been shown to reverse the arthritic process or re-grow cartilage.
Immediately after the injection, you may feel slight to moderate fullness in the joint. You may experience mild local discomfort. Most patients will not experience pain relief immediately. A decrease in your knee pain may only be noticeable after a few days or sometimes many weeks following completion of the series.
If possible, it is best to rest the joint for 24 hours (minimize walking and no gym). Applying ice to the affected area for 20 minutes at a time will help reduce any soreness created from the injection. You can also take Tylenol (Acetaminophen) or Anti-inflammatory medications such as Ibuprofen or Naproxen as long as there are not any restrictions.
Some patients will not be helped by viscosupplementation. For those who report pain relief with the procedure, it may take several weeks to notice an improvement. Regarding how long the benefit from the treatment will last, it varies but some patients report pain relief for several months following the injections.
Unfortunately the answer is no. Viscosupplementation has only been FDA approved for use in the knee. It is not believed to be detrimental, but it has not been proven to be effective in the treatment of OA for other joints.
Side effects are usually minor and limited to discomfort in the area that received the injection.