Healthy joints provide us with a normal level of vital activity. When their condition begins to deteriorate, many problems arise that patients experience at home or during work. There are many ailments that cause not just discomfort, but real suffering - arthritis, arthrosis, etc. Getting rid of them is not so easy. However, timely treatment is required to prevent the development of complications.
To effectively relieve pain and swelling, it is necessary to use medications for a long time and undergo physiotherapeutic treatment. To speed up recovery and rehabilitation, patients are prescribed injections of medications directly into the joint area. This modern method of therapy demonstrates high efficiency.
Who is prescribed injection procedures?
Intra-articular injections are used in the therapeutic process in the treatment of many ailments, for example, arthritis, arthrosis, gout, carpal tunnel syndrome, adhesive capsulitis, etc. This method of administering the drug helps to increase the rate of penetration of the drug into the area of the damaged joint and into the affected tissue. Intra-articular injections of the intra-articular type are prescribed in different situations:
- in case of pain in the area of the knee, hip and shoulder joints;
- when a patient develops bursitis, synovitis or tendonitis;
- when diagnosing arthrosis or arthritis;
- if tendons, ligaments, articular cartilage are damaged.
The specificity of this technique is that it is usually not used as the main method of therapy. Such injections play the role of an effective addition to a complex course of treatment, due to which pain is quickly relieved.
There is another advantage of intra-articular injections - the ability to reduce the dosage of medications taken orally. With this option, the number of contraindications and side effects is significantly reduced, and therefore there is no negative impact on other organs and systems of the body.
Causes of shoulder pain
Patients seeking medical attention with shoulder pain often have a combination of various pathological conditions.
Internal shoulder pain:
- Damage to the rotator cuff.
- Rotator cuff tears.
- “Subacromial pain,” which can be caused by impingement if the humeral head does not descend enough to slide under the acromion at arm height. This pain may be caused by conditions such as subacromial bursitis, tendinitis, or tendinopathy.
- Calcific tendinitis.
- Glenohumeral pathologies: adhesive capsulitis (“frozen shoulder”) or arthritis.
- Acromioclavicular disorders.
- Biceps tendinitis.
- Infection (rare).
- Shoulder instability associated with hypermobility, including subluxation or dislocation.
External shoulder pain:
- Referred pain: neck pain, myocardial ischemia, diaphragmatic pain (gallbladder disease, subphrenic abscess).
- Polymyalgia rheumatica.
- Oncology (apical lung cancer, metastases).
The most common causes of shoulder pain and disability are: rotator cuff injuries, glenohumeral pathologies, acromioclavicular joint disease, and referred neck pain.
Features of application
For intra-articular injections to be effective, they should only be administered by an experienced orthopedic specialist. In this case, the treatment procedure will be painless and will not harm the patient. To carry out the manipulation, a syringe with an elongated needle is used, which is directed directly into the area of the joint space. To minimize errors during intra-articular injection, regular ultrasound monitoring is used.
In some cases, before introducing medications into the joint, fluid is pumped out of it. This is necessary to collect material for research or to eliminate possible complications. When the joint is dry, the doctor injects the medicine into the appropriate cavity.
Some patients mistakenly believe that the intra-articular injection procedure is accompanied by pain. However, this is not true. Since long and thin needles are used for manipulation, the patient’s sensations are no different from standard intramuscular injections. To distribute the medication evenly inside the joint, it is necessary to make slight movements. In some cases, a tight bandage is recommended.
When treating a joint using intra-articular injections, it is not necessary to adhere to strict rehabilitation measures. However, it is advisable to eliminate the load on the limb. This is necessary to prevent complications and increase the effectiveness of therapy. Therefore, it is important to avoid lifting loads and not to drink alcohol.
Block pain in the shoulder joint
Along with other conservative treatment methods (physiotherapy, massage, exercise therapy), blockades are widely used to relieve shoulder pain.
As a rule, the effect after the blockade occurs within a few days and can last for months, but in some cases the symptoms decrease only within 2-3 weeks. The lack of effect may be due to an incorrect diagnosis or the fact that the doctor did not get into the necessary area.
Carrying out intra-articular injections
A joint is a movable “element” with which the body can change position. In the absence of sufficient care for the joint tissue, there is a possibility of developing chronic pathologies of inflammatory etiology, which cause problems with the musculoskeletal system. In this case, an intra-articular injection - a blockade - may be required.
Thanks to such injections, the medication is delivered directly to the affected tissue. Most often, the blockade is carried out as part of a complex treatment against the background of arthritis - a disease of the musculoskeletal system of inflammatory nature. In addition, injections into the joint are used in the treatment of degenerative disorders - arthrosis.
Depending on where the inflammation is localized, the blockade can be carried out in the area of the knee, shoulder, hip or ankle joint. In general, the manipulation is practically no different from a conventional intramuscular or intravenous injection. Medicine is injected into the joint. The duration of the procedure is approximately 5-7 minutes. To achieve the desired result, you may need to do 1 to 3 blockades. This is due to the severity of the patient's condition.
Carrying out an intra-articular injection allows you to:
- quickly get rid of local pain and inflammation in the joint tissue;
- reduce the dosage of tablets taken, which makes it possible to reduce the risk of complications that may develop during systemic treatment.
- If the blockade is performed in compliance with all the rules, the intra-articular injection will be quite harmless and will not lead to negative reactions.
When the patient is accurately diagnosed, the doctor determines which medicine can be used for intra-articular injection into the joint. Typically, the following are used for intra-articular injections:
- glucocorticosteroids;
- hyaluronic acid;
- chondroprotectors;
- anesthetics or antibiotics;
- gas injections.
Only a highly qualified doctor can determine how advisable it is to carry out a blockade.
Intra-articular injection into the knee joint
Intra-articular injections into the joint tissue of the knee are performed for injury that is accompanied by pain. Typically, the medication is administered periarticularly or directly into the joint cavity. Depending on how severe the disease is, the injection is performed on the outside or inside.
When the procedure is completed, the patient notes a significant reduction in pain or its complete absence. In addition, the joint becomes more mobile due to the fact that a protective film is formed on the cartilage tissue. At the end of the manipulation, friction and overload disappear in the joint.
Intra-articular injection into the shoulder joint
The most common cause of pain in the shoulder joint is muscle tissue rupture. In this case, pain can be bothersome both during exercise and at rest. When a person tries to move the shoulder, there is an increase in discomfort.
In such a situation, the doctor may prescribe an intra-articular injection using glucocorticosteroids (for example, Diprospan). Using the pharmacological features of this group of drugs, the appearance of the result is observed a couple of hours after the blockade, and the effect of the drug is observed for almost 3 weeks.
The advantage of this procedure is that it is absolutely painless, which eliminates the use of local anesthetics. In addition, if Diprospan is used during the blockade, complications do not develop.
Intra-articular injection into the hip joint
An intra-articular injection into the hip joint can be performed by an experienced doctor. This procedure is carried out under the control of an ultrasound machine so that the needle gets exactly into the joint cavity.
In addition, the procedure requires special equipment. Such manipulation is effective in the treatment of coxarthrosis in the hip joint tissue.
Intra-articular injection into the ankle joint
An ankle block, as with injections inside other joints, allows the medicine to be delivered specifically to the lesion. Thanks to some medications, pain is eliminated and the inflammatory process is relieved, while with the help of others, cartilage is built up. But the effect of treatment in this case is achieved faster; the course therapy in this case is shorter.
An injection inside the ankle joint is performed by an experienced doctor after the disease has been accurately diagnosed. What medicine will be used to set the blockade is also determined by the attending physician.
The accuracy of the procedure determines how effective the therapy will be, as well as the development of possible consequences. Therefore, intra-articular injections must be performed by a highly qualified specialist in a hospital setting. In addition, it should be taken into account that such treatment of joint tissue has some limitations. So, before proceeding with the blockade, the patient must be comprehensively examined in order to exclude all possible contraindications.
Diagnostics
Laboratory research.
- Blood tests are necessary to diagnose systemic and oncological processes.
- Ultrasonography is the preferred method for imaging the shoulder.
- X-ray allows you to determine bone damage, shoulder dislocation, and arthrosis of the shoulder joint.
- MRI can determine the presence of damage to soft tissue structures or instability of the shoulder. In addition, if the nature of the pain is referred from the neck, MRI of the cervical spine can help in diagnosing the cause of the pain.
- EMNG and EMG - these neurophysiology methods are necessary in cases where there are signs of damage to nerves or muscle function.
Injectable drugs
In the process of intra-articular administration of medications, various groups of drugs are used. Their selection is made by an experienced specialist based on the characteristics of the disease and the patient’s condition. In this case, corticosteroids, chondroprotectors, hyaluronic acid, etc. are most often used.
Corticosteroid group
These hormonal drugs, which are based on corticosteroids, are prescribed to relieve severe inflammatory changes. Corticosteroids in tablets have a similar effect, but intra-articular injections provide faster penetration into the affected area and high therapeutic efficiency. At the same time, side effects on the body are minimal or absent due to the local nature of the medications used.
In the treatment process, it is recommended to give preference to corticosteroid drugs in the form of intra-articular injections, for example, Flosteron, Diprospan, Hydrocortisone, Kenalog, Celeston. In some cases, they are used in combination with anesthetics (Lidocaine) and vitamin preparations.
Intra-articular injections are effective in relieving inflammation, swelling and pain. Thanks to the use of such drugs, joint mobility increases. However, these injections cannot cure the disease itself and ensure the restoration of cartilage tissue.
The achieved effect from their use is about 2-3 months. There is another drawback of corticosteroids - they cannot be used for arthritis of infectious origin. For such a disease, joint lavage and antibiotic administration will be required.
Chondroprotectors
These drugs are prescribed for active degenerative processes in the joint area, which accompany, for example, arthrosis. As a result of such changes, cartilage tissue is destroyed. Chondroprotectors are able to slow down such negative changes and have a positive effect on joint restoration.
The effect of drugs in this group is based on their ability to normalize metabolic processes and stimulate the production of natural collagen. It is this component that is necessary for the construction of cartilage tissue and healing of damage. At the same time, you should not expect an immediate effect. These drugs belong to the group of long-term therapy. The intra-articular injection method helps speed up the action.
Alflutop is often used in the therapeutic process - a simple but effective means for intra-articular injections from the group of chondroprotectors. With an uncomplicated course of the disease, 4-5 injections are usually enough to improve the patient’s condition. Severe diseases require a longer course of treatment.
It is important to remember that the effectiveness of chondroprotectors is manifested not only in the initial stages of the development of degenerative processes. They can also be used in a neglected state. However, in the latter case, their action will mainly be aimed not at stimulating tissue regeneration, but at preventing further destruction of cartilaginous structures.
Hyaluronic acid
Preparations containing this component demonstrate their effectiveness in the treatment of joint problems. Hyaluronic acid is part of the intra-articular fluid, which plays the role of lubricant in the joint structure. It provides protection against injury during movements.
Injections with hyaluronic acid give the intra-articular fluid greater density and viscosity. Therefore, it performs its protective functions better. This component is also involved in the relief of inflammatory processes and promotes the restoration of cartilage tissue.
Injection of acid is prescribed if articular arthrosis is diagnosed. The duration of treatment is 3-5 injections with an interval of up to 5-7 days. To treat a mild form of the disease, one course of drug administration may be sufficient.
In more severe forms - with arthrosis of the second or third degree - the medicine is used annually for 3-4 years. A positive property of this therapeutic effect is the long-term effect – up to 1 year. Doctors recommend using Fermatron, Ostenil, Sinokr.
Gas injections
Carboxytherapy is a modern method used in the complex treatment of diseases of the joints and spine. It allows you to effectively relieve pain. Carbon dioxide is used for injections. It is administered using auxiliary equipment. Due to a sharp increase in the concentration of this gas in the joint structure or muscles after the injection procedure, the body begins to experience an artificially induced lack of oxygen. Therefore, the deficiency needs to be replenished, and blood begins to flow more actively to the affected area.
At the site of intra-articular injection, blood circulation increases and metabolic processes are activated. Carbon dioxide does not harm the body because it is quickly and effectively removed within a short period of time. The positive effect of treatment lasts for a long time. When using injections with gas, no side effects occur, because This component is a natural result of metabolism.
Use of blood plasma for injections
When implementing the PRP method, injection of plasma, which is saturated with platelets, is used. Intra-articular administration of this component helps to significantly activate regeneration processes in tissues, stopping inflammatory changes in them.
The peculiarity of this therapeutic approach is that human plasma is a completely compatible component. Therefore, the patient will not have an allergic reaction, and no side effects will appear. One injection requires taking up to 20 ml of blood. This loss is not considered significant, although doctors recommend excluding increased physical activity.
The method used involves preliminary passage of blood through a centrifuge, as a result of which the plasma is separated. It is this element that is to be introduced into the joint area. The content of platelets in prepared 1 μl of plasma is 1 million units, although in the natural state the concentration does not exceed 200-300 thousand units. The duration of the therapeutic course is 5-7 injections with a break of 3-7 days. Subsequently, the frequency of intra-articular injections is reduced to 1 injection per year.
Doctors note that thanks to a course of injections, it is possible to postpone the moment of mandatory surgical intervention. At the same time, the volume of consumed drugs is reduced against the background of more active healing of damaged cartilage tissue. Injections can relieve pain and swelling and restore the level of joint mobility. Some disadvantages can be considered the high cost of certain drugs for intra-articular injections. However, the effectiveness of treatment is ensured at a high level with long-term preservation of the achieved effect. To avoid complications, you must contact only experienced and qualified specialists.
Contraindications and precautions when performing injections into the shoulder joint
Contraindications:
- Infections (septic arthritis, adjacent osteomyelitis, periarticular cellulitis, severe dermatitis, soft tissue infection, sepsis, bacteremia).
- Increased risk of joint infection (immunosuppression, damaged skin over the injection site).
- Trauma (hemarthrosis, fracture).
- A very unstable joint.
- Joint surgery scheduled for the day.
- Joint prosthesis.
- History of allergies to injectable drugs.
- Poorly controlled diabetes mellitus.
- Uncontrolled bleeding disorder or coagulopathy.
Cautions:
- Patients with diabetes should closely monitor their blood glucose levels for two weeks after the injection.
- Poor blood clotting.
- Immunosuppression.
- Psychogenic pain, severe anxiety.
- Neurogenic disease.
- Active infections (tuberculosis).
- Hypothyroidism.
Intrinsic conditioned adipose tissue
PRP therapy has revolutionized orthopedics. Indeed, instead of the harmful injection of hormonal drugs into the knee (diprospan, kenologu), which give only a temporary analgesic effect but destroy the joint, a method of restorative therapy has appeared that triggers the processes of restoration of articular cartilage. An even more effective treatment technology, ACA (autologous conditioned adipose tissue), involves the introduction of stromal vascular fraction (ACA SVF) and microfat (ACA Microfat). ACA SVF is isolated by mechanical dissociation of adipocytes, thereby concentrating regenerative cells in ACA SVF.