The Center for Regenerative Medicine & Injections

Learn More About Injections:

For patients whose joint pain does not improve with medication or physical therapy, “joint grease” injections may provide temporary relief. The joint is injected with a joint fluid supplement that acts as a lubricant for the damaged joint. Joint injection schedules and duration of relief vary according to the treatment chosen and the individual patient. However, these injections do not cure the diseased joint and joint replacement may be needed as the joint worsens with time.

Depending on the type of injury or pain your are experiencing different types of injections may be chosen. For some joints, injecting fluid into the joint can help to restore lubrication in the joint. In other cases a steroid may be injected to reduce pain or inflammation.

Viscosupplementation

Joints normally have a fluid (called synovial fluid) that acts as a shock absorber. When the synovial fluid thins and loses its elasticity, the cartilage of the joint can wear down causing osteoarthritis pain. Viscosupplementation is designed to mimic the shock absorbing quality of healthy synovial fluid in the knee joints. This involves a preparation of Hyaluronic acid that is injected directly into the knee joint. Hyaluronic acid is a naturally occurring substance found in joint fluid.

Viscosupplementation injections can last up to several months for some patients and has been shown to relieve pain in patients who did not get relief from other non surgical measures of treatment. This has been around in Europe and Asia for several years. The U.S. FDA approved it for use in 1997.

Here in the U.S. it is currently only approved for use in the knee, although other joints trial have been ongoing. Two preparations of Hyaluronic acid are available, a natural product made from rooster combs ( Synvisc) and an artificial one made from bacterial culture’s (Euflexxa) If you are allergic to egg or poultry products or have had a reaction with previous injections, the manufactured product should be used. Your Physiscian can help you make that decision.

Steroid Injections
Intra-articular corticosteroid injections (cortisone) are given to reduce moderate to severe pain. They can provide quick pain relief and reduce inflammation which in turn could help improve the muscle function. However, the effects are not long lasting, possibly up to two months only. Typically no more than three or four injections should be given in a joint in a year. There is also the potential for long term joint damage with frequent repeated injections over a long period of time. Knees, shoulders, hips, ankles and elbows can be injected.

Some injections require a visit to the hospital, where the injection is performed by radiology using fluroscopy to visualize the joint. The shoulder and hip injections to the subacromial space are performed using this technique.

Other injections can be performed in the office. These include injecting steroid into the hip trochanter bursa, the ankle joint, wrist tendons and elbow’s for tendonitis ( tennis elbow).

Injection (Recovery)

Patients are able to return to their usual activity after the procedure, however aggressive exercise should be avoided for 24 hours after the injection.
Physical therapy is sometimes used as an adjunct to the treatment.
When the shots work they can provide relief for several months.
It is possible to repeat the injections if your physician feels you may benefit from a repeat course.
There is no proof that viscosupplementation injections will reverse the progression of osteoarthritis however it may play a role in delaying Total knee Surgery.

KNEE/SHOULDER INJECTIONS

SYMPTOMS

Chronic pain which comes from some form of arthritis, inflammation, or normal wear and tear. Patients who have been diagnosed with chronic chondromalacia may also find relief.

Pain from overuse can sometimes be treated with injection if rest and physical therapy fail to relieve the symptoms.

Knee injuries are not typical candidates for knee injections.

ABOUT VISCOSUPPLEMENTATION

Viscosupplementation has been shown to relieve pain in patients who did not get relief from other non surgical measures of treatment. This has been around in Europe and Asia for several years. The U.S. FDA approved it for use in 1997.

People with OsteoArthritis usually have lower than normal concentration of hyaluronic acid in their joints. Viscosupplementation is most effective in the early stages of osteoarthritis, so be sure to discuss this option with your ProSports physician.

WHAT TO EXPECT

There are three injections. The injections are done once a week for three weeks. The injections are done in the office and take only a few minutes, with little to no pain.

Hyaluronic acid usually begins to work 3-6 weeks after the first injection. You should not expect immediate effects from the first injection. Typically most patients begin to feel less stiffness in their knee first (between 2-3 weeks). Anywhere from 3-6 weeks after the first injection their pain improves.

It should be noted that not everyone will get results from these injections.

ABOUT STEROID INJECTION

Intra-articular corticosteroid injections ( cortisone) are given to reduce moderate to severe pain. They can provide quick pain relief and reduce inflammation which in turn could help improve the quadriceps muscles functiion. However, the effects are not long lasting, possibly up to two months only. Typically no more than three or four injections should be given in a joint in a year. There is also the potential for long term joint damage with frequent repeated injections over a long period of time.

Upon occasion a combination of Viscosupplementation and Steroid can relieve a patients discomfort. You can discuss this option with your doctor.

RECOVERING FROM AN INJECTION

Patients are able to return to their usual activity after the procedure, however aggressive exercise should be avoided for 24 hours after the injection.

Physical therapy is sometimes used as an adjunct to the treatment.

When the shots work they can provide relief for several months.

It is possible to repeat the injections if your physician feels you may benefit from a repeat course.

There is no proof that viscosupplementation injections will reverse the progression of osteoarthritis however it may play a role in delaying Total knee Surgery.

POSSIBLE COMPLICATIONS

Pain, swelling of the knee although rare, are the most common complaints. These normally clear up with 24-48 hours with just some ice and advil. If severe swelling occurs you should return to the clinic as soon as possible.

INJECT OR NOT?

If your Boston Orthopedics and Spine physician has diagnosed osteoarthritis of the knee, and you haven’t found pain relief from physical therapy, application of heat and cold, or pain relievers such as Tylenol, then you should consider discussing injection options.

PLATELET RICH PLASMA

Platelet Rich Plasma (PRP) therapy is a game changing treatment that can relieve the pain and stimulate healing of inflamed joints, tendons, ligaments and muscles. Top athletes have benefited from PRP therapy for years and now this amazing treatment is available to all.

Platelets are naturally occurring cells that play a role in blood clotting and healing. Inside of platelets are a host of compounds that calm inflammation and promote healing, including various growth factors and immune modulating cytokines. Platelets initiate repair and attract stem cells to an area of injury, thus playing a pivotal role in wound healing.

PRP therapy involves drawing the patient’s blood and processing it right in the office to produce a concentrate of platelets, which are then “activated” to release the growth and healing compounds.

Injecting PRP into damaged ligaments, tendons, and joints stimulates the natural repair process. On average, patients can expect to see improvements in 4 to 6 weeks. A series of 2 to 6 injections are typically required, depending on the area and extent of injury or inflammation.

PRP therapy can be used for many conditions including: