We offer a variety of different injections for the treatment of joint pain. All joint injections are done with guidance, either X-ray or ultrasound.  We prefer ultrasound because it is safer for the patient, since there is none of the ionizing radiation associated with X-ray.  We also use a specially formulated “no sting” local anesthetic to numb the skin before all injections. Our joint injection treatments include:

 

Steroid (cortisone) injections

Pros:

Will reduce inflammation, if inflammation is present, and will reduce pain, swelling , and fluid in the joint.

Cons:

Of limited use with osteoarthritis (OA) or degenerative joint disease, which is usually not associated with inflammation.

Pharmaceutical treatment, which means it has a peak action and the effect tapers.

Both local and systemic side effects increase with the dose injected and frequency of injections. Side effects may include weakening of the joint, increased blood pressure, elevation of blood sugar, and decreased ability to fight infection.

Usually limited to no more than 3 injections per year for any particular joint.

 

 

Non-steroid injections

Pros:

Works best in degenerative joint disease or osteoarthritis (OA).

Biologic treatment which means gets better with time and lasts longer than pharmaceutical  treatments.

50% dextrose diluted to 25% with an anesthetic.

Since no cortisone is used, this can be repeated as often as needed.

Typically covered by insurance.

Cons:

Doesn’t work for everyone.

May be safely repeated more often than every three months.

 

 

Artificial Joint Fluid Injections (visco-supplementation)

Hyaluronic acid from rooster combs which works like an artificial joint fluid given by injection.

Pros:

Works in some patients.

Expensive, but usually covered for some joints by most insurances.

Cons:

Usually requires multiple injections with limits on how many times it can be repeated.  Not all joints are covered by all insurances.

Requires prior authorization.

May be no more effective than cortisone injections.

Some “experts” feel risks not worth the benefits.

Can have allergic reactions.

 

 

PRP Injection (Platelet Rich Plasma)

Biologic treatment which means the patient gets better with time and the effect lasts longer than pharmaceutical treatments. Taken from the patient’s own blood and given back the same day.

Pros:

PRP injections are now regularly performed across the country.

Can last 6 months to a year or longer.

Decreases in pain scores and increase in function scores at 6 months.

Sometimes lasts longer, but not everyone gets better.

Cons:

Not covered by insurance so there is a surcharge above what insurance pays

May only prevent additional deterioration.

Even in those studies with symptomatic improvement, there were no MRI changes.

 

 

Stem Cell Therapy

Pros:

Decreased pain scores 75-78% at 6 months.

Able to treat avascular necrosis, which is a condition in which the bone of the joint actually dies.

Increase in both cartilage and menisci by MRI.

Stem cells from adipose tissue (fat) better than bone marrow.

Many more Stem Cells of the type that make cartilage.

Not as painful as other options.

Increase in lifestyle scores by 75% at 6 months.

Dissolved in PRP, so get the benefits of both at one price.

Get stem cell, platelets, fibrin, and growth factors.

Now performed across the country.

Cons:

Often expensive, not yet covered by insurance.