Traditional Medicine

Joint Injections

Fast Facts

  • Joint injection is used to put medications into the joint.
  • Joint injection with medication can provide the relief for the pain and swelling in the joint.
  • The risks for joint injections are minimal. Infection, bleeding, and other major risks are rare.

Joint injections are performed in an office or hospital setting, often with a cold spray or other local anesthesia. After the skin surface is thoroughly cleaned, the joint is entered with a needle attached to a syringe. At this point, medications can be injected into the joint space. This technique also applies to injections into a bursa or tendon sheath to treat bursitis and tendonitis, respectively.

Commonly injected joints include the knee, shoulder, ankle, elbow, wrist, base of the thumb and small joints of the hands and feet. Hip joint injection may require the aid of an ultrasound or X-ray called fluoroscopy for guidance. Some small joints may also be more easily aspirated or injected with aid of ultrasound. Synvisc injections are performed for severe knee pain and degenerative arthritis.

What benefit is derived from a joint injection?

Joint injections may decrease the accumulation of fluid and cells in the joint and may temporarily decrease pain and stiffness. They may be given to treat inflammatory joint conditions, such as rheumatoid arthritis, psoriatic arthritis, gout, tendonitis, bursitis and, also, osteoarthritis.

What usually is injected into the joint space?

Corticosteroids (such as methylprednisolone and triamcinolone formulated to stay primarily in the joint) frequently are used. They are anti-inflammatory agents that slow down the accumulation of cells responsible for producing inflammation and pain within the joint space.

What are the risks of joint injections and aspirations?

Occasional side effects include allergic reactions to the medicines injected into joints, to tape or the disinfectant used to clean the skin. Infections are extremely rare complications of joint injections and occur less than 1 time per 15,000 corticosteroid injections. Another uncommon complication is post-injection flare—joint swelling and pain several hours after the corticosteroid or hyaluronic acid injection—which occurs in approximately 1 out of 50 patients and usually subsides within several days. It is not known if joint damage may be related to too-frequent corticosteroid injections.

Generally, repeated and numerous injections into the same joint/site should be discouraged. Other complications, though infrequent, include depigmentation (a whitening of the skin), local fat atrophy (thinning of the skin) at the injection site and rupture of a tendon located in the path of the injection.

Joint injections also should not be given if an infection is present inside or around a joint and if someone has a serious allergy to one or more of the medications that are injected into a joint. If an infection is suspected, aspirating the joint to gather cultures is essential.

Non-Narcotic Medications for Pain

This “multimodal” approach includes cocktails of medications given to patients before, during and after surgery. The medication is delivered orally, intravenously and through injection into the tissues and nerves around the surgical site. By avoiding giving patients heavy doses of opioids, doctors hope to prevent the risk that patients will become addicted to painkillers. They also avoid the grogginess, nausea, hallucinations and constipation that can result from taking opioids.

Medically Supervised Exercise Program

The Medically Supervised Exercise Program is individually designed and supervised by our team to ensure integration with your care plan

Electromyography (EMG)

Electromyography (EMG) is a diagnostic procedure to assess the health of muscles and the nerve cells that control them (motor neurons).

Motor neurons transmit electrical signals that cause muscles to contract. An EMG translates these signals into graphs, sounds or numerical values that a specialist interprets.

An EMG uses tiny devices called electrodes to transmit or detect electrical signals.

During a needle EMG, a needle electrode inserted directly into a muscle records the electrical activity in that muscle.

A nerve conduction study, another part of an EMG, uses electrodes taped to the skin (surface electrodes) to measure the speed and strength of signals traveling between two or more points.

EMG results can reveal nerve dysfunction, muscle dysfunction or problems with nerve-to-muscle signal transmission.

Your doctor may order an EMG if you have signs or symptoms that may indicate a nerve or muscle disorder. Such symptoms may include:

  • Tingling
  • Numbness
  • Muscle weakness
  • Muscle pain or cramping
  • Certain types of limb pain

EMG results are often necessary to help diagnose or rule out a number of conditions such as:

  • Muscle disorders, such as muscular dystrophy or polymyositis
  • Diseases affecting the connection between the nerve and the muscle, such as myasthenia gravis
  • Disorders of nerves outside the spinal cord (peripheral nerves), such as carpal tunnel syndrome or peripheral neuropathies
  • Disorders that affect the motor neurons in the brain or spinal cord, such as amyotrophic lateral sclerosis or polio
  • Disorders that affect the nerve root, such as a herniated disk in the spine

Assistive Devices / Bracing

If your pain symptoms limit you even slightly, consider using daily living aids and mobility devices to make living your life easier. These products are often called assistive devices because they assist you in all types of movements. Think of an assistive device simply as a tool that makes it easier to function, helps you stay independent, conserves energy, and makes it easier to accomplish daily tasks. Sometimes the introduction of just one simple assistive device can make a huge improvement in everyday quality of life. If symptoms like numbness, tingling, muscle tightness, weakness, or loss of balance present a daily challenge, assistive devices may help.

  • Assistive devices can help you manage many tasks, from brushing your teeth to driving your car.
  • Your physical or occupational therapist is the member of your medical team trained to prescribe and show you how to use an assistive device.
  • Assistive devices are designed to help you stay active, independent and mobile. Learn the proper way to use your new assistive device to optimize your mobility and personal safety.

Trigger Point Injections

Trigger point injections are an effective treatment modality for inactivating trigger points and providing prompt relief of symptoms from myofascial pain syndrome. Myofascial pain syndrome is a common painful muscle disorder characterized by myofascial trigger points. This syndrome is distinct from fibromyalgia syndrome, which involves multiple tender points, though the two pain syndromes may be concurrent.

Myofascial trigger points are a major cause of pain and dysfunction. They produce pain focally and in a referred pattern and often occur in conjunction with chronic musculoskeletal pain disorders. Various modalities for the treatment of trigger points include spray and stretch, ultrasound, manipulative therapy, and trigger point injections.

Not all trigger points require injection or needling. Many active trigger points will respond to physical therapy, especially in the early stages of trigger point formation. However, for chronic trigger points, trigger point injection and needling is an effective treatment.

Conditions involving widespread pain complaints, such as fibromyalgia or endocrine disorder, are not suitable for injections. Treatment is indicated for endocrine diagnoses or fibromyalgia before trigger point injections are considered. In addition, the finding of tenderness alone is not an indication for trigger point injection, because patients with fibromyalgia may also have myofascial pain trigger points.

Diagnosis of Pain

Pain is actually a wide spectrum of disorders including acute pain, chronic pain and cancer pain and sometimes a combination of these. Pain can also arise for many different reasons such as surgery, injury, nerve damage, and metabolic problems such as diabetes. Occasionally, pain can even be the problem all by itself, without any obvious cause at all. Our team has special training in the evaluation, diagnosis, and treatment of all different types of pain. An in-depth knowledge of the physiology of pain, the ability to evaluate patients with complicated pain problems, understanding of specialized tests for diagnosing painful conditions, appropriate prescribing of medications to varying pain problems, and skills to perform procedures (such as nerve blocks, spinal injections and other interventional techniques) are all part of what a pain management specialist uses to treat pain.

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  • Rehabilitation

    Dr. Price perfoms electrodiagnostic (EMG/NCS) testing to determine if you have a nerve that's injured.
  • Electromyography

    Electromyography is a way to tell if something is wrong with your nerves. Nerves are like electrical wires with insulation called myelin.
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  • Medically supervised exercise program

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  • Diagnosis of Pain

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