By: Hope Starkman, M.D.
Your physician may advise you that you might benefit from receiving a soft tissue or joint injection for example an injection into your knee, shoulder, wrist, ankle, and elbow, trigger finger, carpal tunnel area or trigger point. This Procedure most often involves the placement of a form of cortisone into that area with a small needle. Sometimes the cortisone is mixed with Lidocaine because the cortisone/steroid is very thick and by itself can cause an inflammatory reaction. You should advise your doctor if you are allergic to steroids or Lidocaine or anything that might be inside the injection. Also remind the physician if you have bleeding problems or if you take daily blood thinners that might result in excessive bleeding. Usually the needle being used for the aspiration of joint fluid and or injection is the same size as a needle used to drawn blood so excessive bleeding is an unlikely complication.
The physician may use a topical agent like Ethyl Chloride to make the surface being injected cold so the sensation of pain at the surface of the skin may be lessened or alleviated all together.
The physician performing the procedure will obtain your verbal or written consent for the procedure after an explanation of potential risk, benefits and alternatives. The potential risks include bleeding, bruising, contusion, allergic reaction to injected medication or idiosyncratic(unpredictable reaction),possible tendon rupture if you are having a procedure like a trigger finger injection (very rare) or infection. There is often a slight amount of pain which is temporary. Sometimes the arthritis pain at the site of injection may get worse for a day or so before it gets better. Placing an ice pack at the injection site a few minutes on an off for a few hours after the injection may help you to cope with any such discomfort. Not every person receiving an injection will need to use ice after the procedure.
Although your doctor will clean the area off prior to injection, usually with a Betadine or iodine compound to limit risk of infection, it is still possible to acquire an infection from an injection. The risks are very small estimated as 1 in 1,000 to 1 in 16,000. You should immediately notify your doctor if you develop fever, warmth, redness discharge or pain at the injection site or if you have any concern at all.
In some cases other compound may be injected into an arthritic joint. Viscosupplementation is the injection of a compound which in many ways resembles your own natural joint fluid and can act as a lubricant preventing bone from rubbing against bone is osteoarthritis. It often contains Hyaluronic acid. These are considered for use when a patient with osteoarthritis of the knee has failed conservative treatment with weight loss when appropriate, analgesics, and topical agents, anti inflammatory agents, steroid injections, and physical therapy. Some of these compounds are:Synvisc®, Orthovisc®, Supartz®, Hyalgan®, Euflexxa®. Often this type of treatment requires a series of three to five injections each a week apart. The specific therapy chosen may depend on cost, insurance coverage, your physician’s prior experience with each or your prior reaction to above products.
Viscosupplementation can result in a pseudoseptic joint –a joint which seems to be infected but is temporarily inflamed and not infected due to the body’s reaction to the chemical injected. It will go away soon but you need to notify your doctor if pain, redness, warmth or swelling develops at injection site. The same other risks of injection occurs with viscosupplementation as with a cortisone injection.
Injection with steroids or treatment with viscosupplementation can be very effective ways to relieve arthritis pain when one or just a couple of joints are involved. Both procedures may enable a patient to prolong the need for surgery or for total joint replacement, as well.