Musculoskeletal Injection Therapy

    Painful joints and muscles can cause significant morbidity for many individuals. Many medical conditions can lead to this discomfort such as trauma, osteoarthritis, gout and overuse injuries. Curative measures are often nonexistent, but symptomatic pain control can be possible through several means. Some available modalities available are physical therapy, home exercise programs, bracing, surgery and injections.

    While surgical options may provide great relief, many reasons can prevent this from being a viable option. Conservative treatment is generally a good first step because of the limited risk, but these options may not always produce success. Injections have been found to be a minimally invasive, safe option for most people, however, there are a vast variety of injections available and understanding the best option can be confusing to most patients. Some of those options are corticosteroid (cortisone), viscosupplementation (hyaluronic acid, “rooster comb”) or regenerative therapy, such as, prolotherapy or biologics including stem cell injections and platelet-rich plasma (PRP). All of these options have benefits and risks or potential side effects.

    Corticosteroids have been used for many years and have shown to temporarily relieve pain, with note there can be drawbacks. Increased blood glucose levels and potential damage to soft tissues should cause for pause before pursuing this option. However, this powerful anti-inflammatory can help shut down severe acute pain rather quickly for weeks or even several months.

    Viscosupplementation can be a viable option for most people who have joint pain, especially osteoarthritis. These injections consist of hyaluronic acid, which is a component of the typical fluid within a normal joint. It is a viscous or thick fluid that decreases the friction on the surfaces of the moving parts of a joint. This helps decrease inflammation within joints. Because this is part of the physiological fluid in a joint, there are very few serious side effects. In patients with more severe arthritis the effect of these injections tends to decrease.

    Regenerative injections are a more recent addition to the armamentarium that doctors can utilize for joint or muscle/tendon pain. Currently research has been variable as to the success rate of these treatments. The theory in support of these treatments makes logical sense. The intent is to bring to the injured tissue the body’s own healing factors that are typically found within the bloodstream. Platelet-Rich Plasma or PRP works by drawing the patient’s blood from a vein in the arm and spinning it in a centrifuge to separate it into its basic components. The platelet containing plasma is then drawn off with a syringe and inserted into the injured tissue to promote a healing response. Prolotherapy is intended to produce a similar response for a tendon injury but with a different mechanism. During this procedure, a small needle is inserted into the tendon several times after a local anesthetic has been applied. During this procedure a small amount of fluid, typically dextrose (sugar water) is also injected. This is typically performed with the use of ultrasound guidance. This procedure promotes bleeding and initiation of the normal healing process that occurs with most injuries. Tendons tend to have difficulty healing because of significantly decreased blood flow. Therefore, the intent of prolotherapy is to utilize the body’s normal healing ability. Another regenerative medicine treatment is stem cell injections. These injections use the body’s precursor cells to eliminate inflammation. There are many types of options that are classified as stem cells and research is still ongoing as to the benefits and risks associated with these procedures.

    Injection therapy can be a great temporary benefit for people suffering from musculoskeletal pain, especially when surgery is not a viable option. It is important to understand the risks and potential benefits before proceeding. These injections are not necessarily curative but are meant to treat pain, ideally for several months. It is impossible to predict the amount of benefit the patient will receive or even how long it will last. Many factors play into answering these often-asked questions, but the amount of activity as well as the severity of the injury often plays a significant role. Some of these procedures may not be covered by insurance and can therefore be an out-of-pocket expense. It is always important to consult your doctor about questions or concerns before pursuing these treatments, as well as the insurance provider to understand the financial implications.

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