Joint pain, regardless of its location, can significantly disrupt the usual rhythm of life. Joint pain is never spontaneous; it always indicates the presence of an injury or disease. And joint pain will never go away on its own, but will only progress.
Unfortunately, conventional painkillers, regardless of the form (tablets or injections), do not take effect immediately; often improvement does not occur until the third day.
But there is another method - this is the injection of a drug into the affected joint. Injecting drugs directly into the joint helps to achieve the fastest possible effect, because the drug does not need to overcome barriers and undergo changes under the influence of metabolism - the drug immediately begins to work and relief (reduced pain, increased mobility) is achieved as quickly as possible.
Intra-articular injections are an invasive method of treating joints aimed at restoring joint function based on the introduction of medications directly into the joint cavity. The technique helps relieve inflammation, achieve adequate pain relief in the shortest possible time, stop progressive degenerative processes and even promote the regeneration of damaged tissues.
Advantages of intra-articular injections:
- Quick results. Unlike taking drugs in tablet form, intramuscular or even intravenous injections, when the drug is administered directly into the joint, the result comes many times faster. Indeed, in this case, time is not required for the distribution and accumulation of the medicine in the desired area - it has already been delivered by a specialist directly to the problem area and immediately begins to work. Moreover, tablet forms of drugs aimed at restoring cartilage tissue usually require several months to begin working, and when administered intra-articularly, stimulation of regeneration is provided within several hours after injection and lasts as long as the active substance is in the synovial cavity, that is, until moment of natural resorption of the drug.
- Reduced side effects. Again, when taking drugs orally, there is a load on other organs and systems, for example, NSAIDs for pain relief negatively affect the functions of the gastrointestinal tract. Also, with intra-articular administration of drugs, the drug load on the liver and kidneys is reduced, which cannot be avoided with systemic use of drugs.
- Long lasting effect. Unlike other types of therapy, which require frequent repetition of courses, the therapeutic effect of intra-articular injections can last up to a year (and in some cases even longer). The duration of action depends on the drug used, the diagnosis and the degree of damage to the joint.
- Accurate diagnosis. The technique of performing intra-articular injections allows not only to inject drugs into the joint, but also to take synovial (articular) fluid for research, which can radically change the approach to treatment.
- Safety. At MEDIC, only disposable needles and syringes are used for intra-articular injections, which eliminates the possibility of infectious complications, and ultrasound control ensures precise injection of the drug into the cavity of the joint capsule, even in small joints. Also, ultrasound control allows you to avoid injury to blood vessels and, consequently, internal bleeding.
- Minimally invasive. The introduction of certain drugs into the joint helps to avoid or delay (if this degenerative disease is not in the early stages) the necessary surgical treatment. After all, an injection is not as scary as surgery!
What does a therapeutic blockade do?
The main effect is a reduction in pain and discomfort. Inflammation gradually goes away, mobility improves, spasm and swelling are eliminated. The result depends on many factors, including:
- The effect of the active substance at the reflex level on the nervous system.
- The volume of drug in the affected area.
- Analgesic and anti-inflammatory effect of selected drugs.
Patients often notice noticeable improvements the very next day, as joint mobility increases and swelling decreases.
How is the procedure done?
As a rule, intra-articular injection by an experienced specialist usually takes no more than 10-20 minutes. All MEDIC specialists perform this procedure under ultrasound control for patient safety, prevention of complications and maximum targeted impact on the affected area. After all, we are talking about a joint, and it is necessary to inject the drug into the articular (synovial) cavity without damaging the articular cartilage.
A syringe with a long thin needle is used to inject the drug into the joint. After antiseptic treatment of the skin, the doctor makes a puncture in the safest place, and if necessary, local anesthesia is applied. If the choice of puncture site is correct, then an intra-articular injection is not much different from an intramuscular injection, so it is important that the procedure is performed by a highly qualified orthopedic surgeon, surgeon or rheumatologist with experience in this method of treatment.
The needle is then carefully advanced into the joint cavity under visual control using ultrasound. If it is necessary to take fluid for analysis or drain fluid from a joint if there is excess fluid, the first step is to partially drain the joint, and then carefully inject the drug. After the injection, it is necessary to carry out motor activity of the joint (for example, when treating a knee joint, you should bend and straighten the leg at the knee several times) so that the drug is better and faster distributed in the cavity. In some cases, a tight bandage is applied to the joint, or an orthopedic joint bandage or support is used.
No special care or rehabilitation is required after intra-articular injections, you just need to follow the necessary recommendations: do not unnecessarily load the joint in the first days after the injection, avoid hypothermia and overheating, and drinking alcohol.
Indications for intra-articular injections and local injection therapy:
- Arthritis and arthrosis of any origin
- Bursitis
- Joint tunnel syndrome
- Periarthritis
- Rheumatoid and rheumatic joint lesions
- Gout
- Synovitis
- Traumatic joint damage
- Tenosynovitis
- Adhesive capsulitis
- Acute joint pain
Preparations for intra-articular injections
Depending on the diagnosis, the purpose of treatment, as well as concomitant conditions and diseases, drugs from one of the following groups or a combination thereof are usually used for intra-articular injections:
Topical corticosteroids
Drugs of choice for fast and high-quality pain relief. Corticosteroids are medications based on adrenal hormones that help relieve inflammation, swelling and pain in the shortest possible time. They do not have a negative effect on the body as a whole, since they work in a limited space. If there is an inflammatory effusion in the joint cavity or periarticular bursa, it is impossible to fully influence the source of inflammation without the use of corticosteroids, so they are usually prescribed at the beginning of treatment for adequate pain relief and relief of active inflammation, after which it becomes possible to use other methods of therapy - physiotherapeutic procedures, physical therapy and drugs aimed at restoring damaged cartilage tissue and synovial fluid.
The effect of intra-articular injection of corticosteroids lasts on average from 3 weeks to 2-3 months, which significantly exceeds the effect of any analgesics in the form of ointments or tablets.
It should not be used if there is an infectious lesion of the joint, since hormones will only “untie the hands” of the infection. They do not affect the cause of the disease, but quickly and efficiently eliminate the symptoms, improve the general condition and prepare the joint for further targeted treatment.
With prolonged and irrational use, they can increase degenerative changes in cartilage tissue. Our specialists will never put patients’ health at risk and use corticosteroids only when indicated, avoiding negative consequences.
The most common drugs in this group: Diprospan, Kenalog, Hydrocortisone, Celeston and others.
Hyaluronic acid preparations
Effective means for the treatment of joint diseases in the second and third stages.
Since hyaluronic acid is a natural component of synovial fluid and an important component of cartilage tissue, the use of preparations based on it improves and accelerates the regenerative processes of cartilage, and also improves the quality of synovial fluid, making it thicker and more viscous. By filling the joint cavity, hyaluronic acid uncouples the rubbing articular surfaces and provides their lubrication; accordingly, pain decreases and the range of motion in the joint increases. Along with this, hyaluronic acid compensates for the deficiency of the necessary components of the extracellular matrix necessary for the self-healing of cartilage tissue.
To achieve a lasting therapeutic effect for arthrosis, a course of 3-5 injections is required at intervals of several days. For the treatment of arthrosis of the second or third stage, the course must be repeated annually.
The effect of intra-articular injection of hyaluronic acid preparations can last up to a year. Effective certified hyaluronic acid preparations are usually used, such as Fermatron, Ostenil, Duralan, Sinvisc, Giruan and others.
Chondroprotectors
Effective means for relieving inflammation and pain, as well as preventing the progression of degenerative changes in cartilage tissue. Chondroprotectors also contain substances that are part of the cartilage matrix (collagen, glucosamine and chondroitin), which increases the ability of one’s own tissues to recover independently.
The most common drug in this group is Alflutop. A chondroitin sulfate drug called Mucosat is also used.
As a rule, a course of several injections is required. In the early stages of arthrosis, the therapeutic effect of the use of chondroprotectors is long-lasting. At the second or third stage, drugs of this group are used to prevent the progression of destruction of cartilage tissue, since due to the massiveness of the affected tissue, its independent restoration is impossible.
Patient's blood plasma enriched with platelets
An effective method of triggering the regeneration of affected tissues, allowing one to avoid allergic reactions or intolerances, since the active substance is not foreign to the body.
To carry out intra-articular plasma injections, a small amount of blood is taken from a patient’s vein into a special tube, which is then placed in a centrifuge, where it is prepared. After centrifugation, the blood is separated into platelet-rich plasma and red blood cells.
Such plasma effectively relieves inflammation and stimulates active regeneration of cartilage, because platelets, in addition to their main function (blood clotting), are capable of releasing growth factors to activate the regenerative processes of cell division and growth in damaged organs and tissues.
Synthetic synovial fluid prostheses
These drugs are used at later stages - the third and fourth stages of arthrosis, when other drugs are no longer effective. They often make it possible to delay surgical intervention for joint replacement. And for people for whom surgery is contraindicated due to the presence of concomitant diseases, this method is sometimes the only one that helps reduce pain during movement and improve the quality of life.
For endoprosthetics, the well-proven drug Noltrex is usually used. It is a hydrogel based on polymers with high biocompatibility and allows you to effectively and permanently prolong the functioning of the joint.
It does not contain components of animal or bacterial origin, therefore it does not cause allergic or autoimmune reactions, since the body “does not see” it and does not try to reject it or attack it with phagocytes. Noltrex, being a synthetic biopolymer, also does not undergo natural decay, so the positive effect lasts longer than from other products (up to several years). In some cases, one or two injections of the drug are enough to achieve stable remission. But for arthrosis of the third or fourth stage, it is necessary to repeat the administration of Noltrex regularly, once every year and a half. This allows you to maintain the natural mobility of the joint, eliminates the progression of degenerative-dystrophic changes in the cartilage tissue by reducing the mechanical abrasion of the articular surfaces against each other.
Its properties are as close as possible to the consistency of one’s own synovial fluid and serves as an effective long-lasting lubricant.
© Clinic "Medic" in Moscow - Make intra-articular injections into the knee, shoulder, hip, and ankle joints.
Impact points
There are 5 types of therapeutic injections:
- Intra-articular - the medicinal drug is injected directly into the joint cavity.
- Paravertebral - the injection is carried out in the area next to the vertebrae.
- Epidural - a needle is inserted into the epidural area (performed only in a hospital).
- Periarticular - the drug is injected into the muscles and ligaments located next to the affected area.
- Intraosseous - a needle is inserted into the affected bone tissue.
The number of injections and the area of administration of the drug are determined by the attending physician based on medical history and diagnostic information. In many cases, only one injection is required into the affected area with pronounced pain. To achieve the best result, experts inject the medicine into several areas, including the area of pinched nerve plexuses and areas of hypertonicity of muscle tissue.
Pathogenesis
The mechanism of the onset and development of the disease is not always clear to doctors. Often, specialists are unable to determine what exactly led to the appearance of the pathology. But in most cases, the pathogenesis of arthrosis of the hip joints is provoked by the following factors:
- mechanical (damaging);
- genetic;
- hormonal;
- metabolic.
Damage to cartilage tissue is the most common cause of pathology. Injury causes cartilage cells called chondrocytes to divide and stimulate the production of cytokines. The latter trigger an irreversible process, gradually destroying the joint and having a toxic effect on it. Another development-stimulating factor is inflammation of the synovial membrane of joints or ligaments, accompanied by the accumulation of fluid in the free cavity.
Hormonal imbalances in the body reduce the elasticity of articular cartilage and reduce its resistance to physical stress. As a result, the lower limbs become more vulnerable - this leads to the proliferation of bone tissue and stimulates subsequent degradation. There are cases when arthrosis of the hip joints is inherited. The reason for this is a mutation in the genes responsible for encoding the molecules of articular cartilage.
Possible complications
Coxarthrosis is a dangerous disease that must be treated regardless of its degree. Otherwise, there is a risk of complications and the pathology moving into an advanced stage. Timely treatment of coxarthrosis guarantees a quick recovery and return to a normal lifestyle. Conservative therapy helps prevent the following complications:
- inflammatory and infectious processes in adjacent tissues;
- subluxations of the hip joint;
- pinched sciatic nerve;
- bursitis or inflammation of the bursae;
- tenosynovitis;
- tunnel symptom;
- fractures or necrosis of bones.