Definition and Overview
Certain medication and substances can be injected directly into the joints to treat diseases, injuries, and other medical problems that affect the area.
There are many joints in the human body and they can be found in the skull, spine, fingers, toes, knees, elbows, and hips, among others. They are a part of the musculoskeletal system where the bones are connected and allow for movement and articulation.
Because they are necessary and instrumental for movement and articulation, issues in the joints can easily immobilize the patient. Mild pain in the joints can cause discomfort when moving a certain limb or part of the body while severe pain in the joints can disrupt normal activities.
Aside from injury and trauma, other possible conditions that can cause pain to the joints are the following:
- Osteoarthritis - This typically affects patients over fifty years old and erodes the smooth cartilage covering the joints. This condition causes the cartilage to thin, making movement difficult and stiff. Over time, the joints develop inflammation and osteophytes, which are spur-like bony growths around the tissues and bones. This condition commonly affects the joints in the hips, knees, spine, and hands.
- Rheumatoid arthritis - This is a condition of the immune system that targets the patient's joints, resulting in pain and swelling because the synovium, or the outer covering of the joints, become inflamed. The condition also causes this outer layer to change shape, and break down both the cartilage and bone. This is more common in older patients, with females being at higher risk than men.
- Tendinitis - In this condition, the tendons in the joints become inflamed, and the patient experiences an increase in temperature, visible redness, and the appearance of knots around the affected joint.
All three conditions can be debilitating, and severe cases cannot be simply treated by therapy or medication. Corticosteroids and other types of steroids can be injected directly in the joints to reduce inflammation immediately. Once the inflammation is reduced, the patient will feel quick relief from their symptoms.
There are also types of injection-based joint treatments that involve aspiration, or removal of fluids in the joints and surrounding areas to relieve pain.
Who should undergo and expected results
Patients suffering from severe forms of the conditions above should discuss joint injections with their doctor. The treatment is not meant to completely cure the condition but provides immediate pain relief and reduces inflammation in the affected area.
How the procedure works
The procedure can be performed by a general practitioner, sports physician, physiotherapist, an orthopaedic surgeon, or a rheumatologist. It can also be performed by a qualified and properly trained nurse. The injections will be administered in a hospital or clinic.
In some procedures, anaesthetic can be provided either by applying it topically or injecting it before the steroids. The anaesthesia is meant to reduce minor pain or discomfort that might occur during the procedure. The skin in the affected area will be cleansed with alcohol or with a sterile wipe.
The steroid will then be injected into the affected joint. If the patient chooses to have local anaesthesia, the substance can be combined with the steroids in a single syringe.
For larger joints, the patient will undergo an ultrasound or x-ray to determine the exact location for the injection.
If the patient is suffering from severe arthritis, the doctor will drain fluid (joint aspiration) from the area before injecting the steroids.
After the procedure, the patient will be allowed to go home but must refrain from activities that might put strain or pressure on the treated area. However, if the patient has received injections in the spine or hips, he or she will need a companion to go home.
The steroid injections are a form of symptom management. They have to be repeated every three to six months.
Possible risks and complications
Complications of joint injections are quite rare, but there are isolated cases of bleeding and infection. Patients have to make sure that they have the injections done in a reputable hospital or clinic, and are performed by a qualified medical professional.
Some patients might feel an increased pain in the area after the injection. This phenomenon is normal and is known as a steroid flare, which can be easily addressed by over-the-counter pain relievers.
Some patients might observe thinner skin or discoloration in the area where the injections are administered, which is normal for repeated injections.
Though rare, some patients also report irregularities in their menstrual cycles, as well as changes in moods and sleep pattern.
Arthrocentesis and Injection of Joints and Soft Tissue. In: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR. eds. Kelley's Textbook of Rheumatology. 9th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 5.
Malfair D. Therapeutic and diagnostic joint injections. Radiologic Clinics of North America. 2008;46,(3):439-453.PMID: 18707956. Available at: http://www.ncbi.nlm.nih.gov/pubmed/18707956.