Peripheral Joint Injection

Treatment

Intra-articular peripheral joint injections provide physicians with an effective modality to help treat conditions, such as chronic joint pain, degenerative musculoskeletal diseases, and rheumatoid arthritis. Injections for chronic joint pain have come a long way since they were first described in the 1930s.
The first intra-articular injections used a formulation of glycerin, petroleum jelly, lipodil, and formalin. Today, intra-articular injections are composed of strong corticosteroid medication, which offers a much better clinical response.

The commonality between the aforementioned conditions is that they all cause inflammation, which may culminate in chronic pain and may lead to eventual joint deterioration and loss of mobility. Several randomized studies regarding the use of intra-articular peripheral joint injections have proved clinical efficacy regarding better pain control and improved range of motion in patients suffering from a variety of inflammatory joint conditions.

Intra-articular-Peripheral-Joint-Injection-2The physician’s goal when administering an intra-articular peripheral joint injection is to relieve the inflammation and pain through the injection of powerful anti-inflammatory corticosteroids into the aggravated joint. Studies have shown that on a cellular level, these intra-articular steroids bind to a cell’s nucleus and reduce lysosomal enzyme release, phagocytosis, and inflammatory mediators. Pain is often decreased due to the reduction of these inflammatory mediators. The particular choice of steroid is usually related to the personal preference of the physician. However, in a survey conducted by the American College of Rheumatology, about one-third of physicians frequently used the steroid, methylprednisolone, while another one-third favor triamcinolone hexacetonide, and about one-fifth of physicians preferred to use triamcinolone acetonide. Local anesthetics, such as lidocaine, are often combined with the corticosteroids. Some recent investigations have indicated that some anesthetics may also have a transient anti-inflammatory effect.

How Is An Intra-Articular Peripheral Joint Injection Performed?
Intra-articular-Peripheral-Joint-Injection-1This non-invasive procedure is performed in an outpatient setting with a relatively short treatment time. The effects of intra-articular peripheral joint injections are typically seen within two days following the procedure. Relief can be long-lasting and may provide long-term therapeutic benefits. When effective, they can be part of an ongoing chronic pain treatment program. In many cases, intra-articular peripheral joint injections have allowed for enhanced mobility and substantial improvement to a patient’s quality of life. Prior to the intra-articular peripheral joint injection, the patient is comfortably positioned sitting or lying down. The patient’s skin at the site of the injection is then thoroughly sanitized with an antiseptic solution. After the injection begins, the physician may rely on fluoroscope guidance to help with accurate needle placement into the affected joint. The physician may also use a local anesthetic along with the steroid injection to help with the pain-relieving effects of the treatment. After the corticosteroid medication is injected, the patient will experience tingling and numbness in that area. Intra-articular-Peripheral-Joint-Injection-4At the conclusion of the procedure, the patient is moved to a recovery room in order for the medical staff to monitor the injection’s effects. Because of the administration of the local anesthetic with the steroid medication, patients may feel immediate pain relief.Patients are encouraged to keep activity to a minimum for at least 24 to 48 hours after the procedure. If swelling occurs at the site of the injection, ice may be applied as needed.

As with all injections, potential side effects or complications may include temporary tenderness at the site of the injection, hematoma, bleeding, infection, and allergic reaction. In most patients, pain relief occurs within one to two days and may last from a couple days to six months. Pain-Doctor-Knee-Injection-Procedure-3Follow-up injections can also be performed in the long-term treatment of joint pain. However, it is important that physicians actively monitor the frequency of intra-articular peripheral joint injections in order to prevent eventual weakening of the tendons or bone in which the injections were administered. Pain relief from the initial intra-articular peripheral joint injection confirms that particular joint as the source of pain. However, if pain persists after the initial injection, additional diagnostic tests may be warranted to help locate the source of the pain. Self-measurement of pain relief is an important part of identifying the effectiveness of the procedure. Because steroids typically have delayed effects, it may be helpful to keep a pain diary to track the pain response during the weeks following the procedure.

Conditions Related To Intra-Articular Peripheral Joint Injections
knee pain-2In the 1950s, researchers discovered that corticosteroids were beneficial for treating a variety of inflammatory conditions, which include degenerative bone diseases, rheumatoid arthritis, and joint injuries. Regardless of the cause, if left untreated, chronic inflammation can cause deterioration of the joints, which may damage the surrounding tissues. Intra-articular peripheral joint injections have been routinely recommended to patients who have not had success with mild analgesics and non-steroidal anti-inflammatory drugs (NSAIDs). They have also been widely used to treat patients who may not be suitable candidates for surgery because of potential health conditions. Physicians routinely perform intra-articular peripheral joint injections to treat inflammatory conditions in a variety of joints; however, the most common areas include the shoulder joints, ankles, knees, and elbows. Regardless of the location, the powerful steroid released through the injection possesses anti-inflammatory properties that, in most cases, do not cause typical complications associated with oral steroids, such as muscle weakness, peptic ulceration, skin thinning, and aggravation of diabetes.

Source: Know Your Back

Staff

Jonathann Kuo, MD
Pain Medicine / Executive Director
Raul Cortes, MD FACS
Surgical Director / Plastic and Reconstructive Surgery
Risa Ravitz, MD
Neurology / Pain Medicine
Robert Zhang, MD
Pain Medicine / Anesthesiology
Jessica Au, MD
Sports Medicine / Pain Medicine
Tanuj Palvia, MD
Pain Medicine / Fellowship Director

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