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.
What is a joint injection?
In the absence of a significant effect from drug treatment, many turn their attention to intra-articular injections. This method allows you to quickly achieve improvement, and the effect lasts for a long time.
The definition is already included in the name - this is an injection that the doctor makes into the cavity of the affected joint. With the help of a blockade, medicinal substances penetrate into the joint, which relieve pain and inflammation and rehabilitate cartilage tissue.
Intra-articular injections are indicated for joint damage, hemorrhage and carpal tunnel syndrome. Using an injection, steroid hormones, B vitamins, hyaluronic acid and painkillers are injected into the joint cavity or periarticular tissue. Using this manipulation, you can also remove accumulated pathological fluid.
In orthopedics, such injections are performed on a regular basis and are part of clinical recommendations for the treatment of osteoarthritis of the knee and hip joints. When contacting a medical institution, you should find out in advance whether the necessary drug is available or should be ordered in advance, and whether treatment is free if you have a compulsory medical insurance policy if you go to a public clinic.
No. 1. Why are intra-articular injections better than intramuscular ones? Or do they give the same result?
Intra-articular injections are more effective than intramuscular injections because the medicine is delivered directly into the affected joint. A variety of medications are sent into the cavity, which relieve pain and inflammation, restore cartilage tissue, and become synovial fluid prostheses. The main thing is that they act in a targeted manner. Intramuscular injections are less effective, since the active substance is distributed throughout the body through the bloodstream and enters the joint in a much lower concentration.
Intra-articular injections hit the target exactly – they act on the affected joint
Types of joint injections
Three types are used:
- paraarticular;
- periarticular;
- intra-articular.
Paraarticular
The method involves injecting medication into the tissue of the damaged joint. At the moment, this is one of the most effective ways to help the patient relieve pain and relieve inflammation. In this case, intradermal and subcutaneous administration is performed using thin and short needles. The injections are practically painless, and the procedure itself is completed quickly.
Periarticular
blockades are indispensable for osteoarthritis affecting a large area, arthritis and periarthrosis. The drug is injected into the tendon and muscle tissue.
Intra-articular
The method involves introducing a substance into the joint tissue.
Who is indicated for intra-articular injections of hyaluronic acid?
This manipulation is recommended for patients with the following diseases:
- arthritis, including complications of gout, osteoarthritis, psoriasis, rheumatoid arthritis;
- synovitis and injuries that provoke it;
- severe pain;
- damage to periarticular tissues;
- adhesive capsulitis;
- carpal tunnel syndrome.
In addition, this method is ideal for those people who experience gastrointestinal dysfunction, since as part of complex therapy for the underlying disease it will help reduce the amount of medications taken orally.
Preparations for intra-articular injections of hyaluronic acid are very diverse. In each specific case, the specialist selects the appropriate concentration of the substance depending on the condition of the patient’s tissues.
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.
The principle of action of an injection with hyaluronic acid
Preparations for intra-articular injections with hyaluronic acid, which have been produced in Russia for several years using Swiss technology, are Ripart and Ripart Long. They are produced by fermentation, which allows for optimal action on affected cartilage tissues.
Medicines injected into the joint create favorable conditions for the restoration of cartilage tissue, providing better shock absorption and mobility. Since drugs containing hyaluronate can remain in the joint for a long time, from six months to 12 months, the recovery process occurs gradually, and its effect lasts for a long time.
In this way, the manifestations of arthrosis in the future can be reduced to a minimum. So-called “liquid prostheses” are indispensable for elderly patients who want to avoid surgery.
PRP plasma therapy for joints (plasmolifting)
The therapeutic effect of PRP therapy is based on the use of platelets - blood cells that initiate the coagulation process and play a key role in the process of cell regeneration. A study by scientists from the University of Michigan (USA), published in 2010, proved the presence of biologically active cells in platelets, the so-called “Growth Factors”. Six different types of growth factors have been discovered that act on different parts of the body: epithelial growth factor (EGF), vascular endothelial growth factor (VEFG), fibroblast growth factor (FGF), insulin-like growth factor (IFG), transforming growth factor (TGF- β) and platelet-derived growth factor (PFDG). There are other growth factors, but what they all have in common is that they are natural compounds that act as activators of the process of restoration and growth of new tissues in the body, and therefore are actively used to treat various diseases. When plasma of one's own blood, saturated with platelets and growth factors, is introduced into the joints, the process of regeneration of cartilage and articular tissue is launched, and with a course of use, complete restoration of the joint is possible.
Medical invites you to get an injection for joint pain at competitive prices!
Efficiency of the procedure
Sodium hyaluronate is used, as a rule, in cases where corticosteroid drugs do not bring a visible effect and do not relieve the patient of pain. This procedure cannot be avoided when treating elderly people due to changes in the composition of the intra-articular fluid, which over time loses its nourishing and shock-absorbing functions. The cartilage becomes thinner and dries out, causing bone deformation.
In cases where the patient wants to do without surgery, and it is necessary to reduce pain as quickly as possible and at the same time avoid the use of anti-inflammatory drugs, hyaluronic acid is the only way out.
Possible side effects
With strict adherence to the rules of manipulation, side effects can be completely avoided. Specialists at the Yuzhny clinic recommend carefully ensuring that the doctor thoroughly cleans his hands before the injection, puts on gloves and disinfects the injection site. The syringe must also be in individual sterile packaging, and the ampoule with the drug must be hermetically sealed. After the injection, the doctor places a sterile napkin on the joint; in this case, unwanted infectious complications can be avoided.
One of the common mistakes is an incorrectly selected needle, which, when inserted, can damage the periosteum or enter a nerve or vessel. With careful adherence to technique and good knowledge of anatomy, such errors should not occur.
Common adverse reactions to injections of drugs containing hyaluronan are slight swelling at the injection site and slight pain. The patient’s condition can be adequately assessed within two days, when the primary symptom disappears.
Some forms of injection can cause significant swelling, inflammation and increased pain - the so-called pseudoseptic reaction.
Drugs used
Substances that are used to treat arthritis and osteoarthritis are divided into several types:
- local anesthetics;
- chondroitin and glucosamine;
- steroid drugs;
- preparations containing sodium hyaloranate;
- specific medicinal substances, for example, platelet-rich plasma or ozonated solutions.
With the help of local anesthetics or painkillers, you can quickly achieve the effect of reducing pain and reducing sensitivity in the affected area, but it is worth keeping in mind that this will not be enough to treat joints.
To reduce swelling, glucocorticoids are used, the effect of their use lasts up to one month. These are the same corticosteroids that come in tablet form. When injected directly into the joint cavity, they are much more effective; in addition, this method avoids side effects such as dizziness and gastrointestinal problems.
Since these drugs are hormonal, it is recommended to use them no more than 3-5 times a year. For a disease such as infectious arthritis, the use of corticosteroid drugs is strictly prohibited. Instead, specialists use rinsing of the joint capsule and administer antibacterial drugs.
Drugs from the group of chondroprotectors help improve metabolic processes due to the human body producing its own collagen. This is a fibrillar protein that lies in the connective tissue of the body, the main building material for cartilage tissue and joints. A sufficient amount of it in the human body helps to cope with minor injuries on your own, without visiting a doctor.
The optimal solution for joint damage is the use of a so-called synovial prosthesis. A healthy human joint contains viscous and elastic synovial fluid; it protects the surface of the joints from chafing and protects against injury. Using intra-articular injections with hyaluronic acid, specialists managed to obtain the required consistency of injections, which will help not only relieve pain, but also restore damaged cartilage tissue.
The so-called PRP method, or injection of the patient’s blood plasma into the joint, is also often used. The plasma is first enriched with platelets. The advantage of this manipulation is that the patient cannot have allergic reactions to his own plasma, side effects are excluded.
Carboxytherapy is one of the new methods based on carbon dioxide injections. Its introduction into the joint accelerates blood circulation and metabolic processes. Its administration requires the use of special equipment, so this procedure is not so popular.
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.
Intra-articular injections of hyaluronic acid for osteoarthritis
Osteoarthritis occupies a leading place in prevalence; the number of people suffering from this disease in Russia is more than 15 million people.
Nowadays, there are many drugs based on hyaluronic acid, which vary depending on the production method, molecular weight and concentration of hyaluronates.
In the knee joint
Intra-articular injections of hyaluronic acid into the knee joint will help compensate for the deficiency of intrinsic fluid in the joint. They are indicated for diseases such as synovitis, bursitis and tendinitis.
The use of injection techniques as part of an integrated approach to eliminate degenerative-dystrophic pathology has shown good results in almost all patients, especially in the early stages of pathology development.
Contraindications to an injection into the knee joint are allergic and autoimmune reactions that increase inflammation in this area, and the complete destruction of articular cartilage.
Oral medications and ointments or creams for external use are prescribed as accompanying medications. After the injection, the patient is advised to avoid excessive exercise.
In the hip joint
This movable joint of the bones of the human skeleton is one of the most complex components of the musculoskeletal system. Pain in the hip joint, unlike the knee, can occur even at rest, especially at night, which causes a lot of inconvenience and leads to a sharp deterioration in the quality of life.
Injections are usually used in cases where an effective method of treating elderly people diagnosed with coxarthrosis is needed.
Intra-articular injections of hyaluronic acid into the hip joint allow you to quickly deliver the drug to damaged tissues. Sodium hyaluronate in the injection will help improve the sliding of the surface of the contacting cartilages and restore their elasticity.
As a rule, in cases with the hip joint, it is necessary to first take an x-ray. Often there is a need to remove accumulated fluid from the joint capsule.
Injections for joints: what to expect from the procedure and how much will the treatment cost?
Interview with an orthopedic doctor, Ph.D. Litvinenko Andrey Sergeevich
With chronic joint pain, morning stiffness and limited movement, a person is ready to use any means to quickly restore his well-being. If the pills do not help, it makes sense to pay attention to intra-articular injections. Using this method, you can achieve fairly rapid improvement and at the same time maintain a positive result for a long time after the procedure.
We asked Andrey Sergeevich Litvinenko, Candidate of Medical Sciences, an orthopedic doctor with 15 years of experience, to tell us what joint injections are and how effective they are.
Andrey Sergeevich, recently, more and more often, orthopedists are prescribing intra-articular injections to patients. What is this procedure and what are its advantages over, for example, intravenous or intramuscular injections?
A.S. Litvinenko (hereinafter - A.S.):
The essence of the method is already reflected in its name - it is an injection of drugs into the cavity of the affected joint.
With the help of injections, substances can be delivered into the joint cavity that will relieve inflammation, relieve pain, restore cartilage tissue, or even become substitutes, synovial fluid prostheses. The main advantages of this method are speed and targeted impact.
After intravenous or intramuscular injections, the active substance is distributed throughout the body through the bloodstream and only then, in a small concentration, enters a specific organ. But it is not always necessary, for example, to suppress inflammation throughout the body. When an anti-inflammatory drug is injected into a joint, we act directly on the “sore” area, and all other organs work as usual.
Are there any studies confirming the effectiveness of the approach?
A.S.:
Yes, sure. Research on the effectiveness of drugs for intra-articular injections for various diseases is carried out every year.
For example, interesting studies have been conducted on the use of hyaluronic acid preparations (editor’s note - Olyunin Yu.A. The use of hyaluronic acid preparations in the complex therapy of osteoarthritis // Yu.A. Olyunin Modern Rheumatology. 2021. No. 2. pp. 64–69)
, platelet-rich plasma
(editor's note - G.D. Lazishvili. The use of platelet-rich plasma in the treatment of osteoarthritis // G.D. Lazishvili, K.A. Egiazaryan, A.P. Ratiev, M.A. Danilov / Moscow Surgical Journal . 2015. No. 5 (45). pp. 14–21)
and even ozone therapy
(editor’s note - Zakhvatov A.N. The effectiveness of intra-articular ozone therapy for traumatic injury to the knee joint in an experiment // A.N. Zakhvatov, A.N. Belyaev, S.A. Kozlov, M.I. Piyanzina, S.I. Kuznetsov, A.M. Leshchanov / Bulletin of RUDN, series Medicine. 2009. No. 4. pp. 301–303)
for the treatment of osteoarthritis and traumatic joint injuries . Such methods can relieve inflammation, improve cartilage regeneration and synovial fluid production. This is an excellent alternative to traditional anti-inflammatory drugs.
I think in the coming years there will be new research, new drugs and treatments that will help more effectively manage pain and improve joint mobility.
Most people associate the procedure with intra-articular injections in the knee. Is the scope of application of the approach limited to this?
A.S.:
The knee is a complex joint that is very easy to injure.
That’s why we hear most often about treating the knee joint with injections. But intra-articular injections are also used for damage to the shoulder, elbow, hip joints and even the wrist and hand. From the Editors Around the world, every fifth person consults a doctor with complaints of limited mobility or pain in the joints.
In Russia this is about 25 million people [1]. For injections into small joints, thin and short needles are used, like an insulin syringe. For the shoulder or knee joint, the needles must be longer in order to reach the joint cavity itself. And if an injection into the hip joint needs to be given to an overweight patient, sometimes you have to select a special needle.
Intra-articular injections are used in the treatment of arthrosis, injuries, tunnel neuropathy, bursitis, rheumatoid joint damage, tendinitis, tenosynovitis. That is, in cases where it is necessary to relieve pain, reduce inflammation, stimulate cartilage restoration, and increase the volume of synovial fluid.
Are there any contraindications?
A.S.:
Do not use drugs to which the patient is allergic or intolerant. If there are lesions or rashes on the skin at the injection site, it is also better to postpone the injection. The same applies to infectious diseases - there is no point in going to an orthopedic doctor when you have the flu or a cold.
How much pain does the patient experience when the drug is injected directly into the joint?
A.S.:
The sensations from an injection into a joint and from the injection of medicine into a muscle are almost the same. Before the procedure, the patient must undergo a consultation with an orthopedist, and in some cases, additional examination. You need to make sure that the injections will be effective and will not cause harm. The doctor selects the drug and sets the time for the procedure. Drugs for intra-articular administration can be quite expensive, so they are sometimes delivered to order.
During the procedure, the doctor treats the injection site and inserts the syringe needle so that it enters the joint cavity. If the technique is followed, the needle passes through soft tissue without touching either nerves or bone. Of course, there is discomfort, but no more than with a regular injection. The drug is administered slowly, especially if it has sufficient viscosity.
From the editors An injection into the same joint can be done in several ways. For the shoulder joint, there are two access points that the doctor can use. An injection into the knee joint is usually done in one way, but in order to pump out excess fluid from the joint, the doctor can use as many as three points.
In difficult cases, the medicine is administered under ultrasound guidance. This allows the doctor to accurately enter the joint cavity. This additional control is more often used for injections into the hip joint. The joint itself has a complex configuration and difficult access. And if the patient is overweight, then successfully performing a “blind” injection becomes a non-trivial task.
After the injection, you will need to make several movements in the joint. This way the drug will be more evenly distributed in it. After this, they can apply a tight bandage or simply cover the injection site with a sterile napkin and adhesive tape. Actually, this is where the procedure ends. No rehabilitation or recovery period is required.
Are there possible complications after the procedure?
A.S.:
If you strictly follow the rules for intra-articular injections, there are no complications. Carefully ensure that the doctor cleans his hands before the procedure, puts on gloves, and be sure to treat the future injection site. He must remove the syringe from the sterile package and open the ampoule with the medicine. After the procedure, the injection site should be covered with a sterile napkin. Not the one that was used to wipe the skin, but a new one. If all these rules are followed, then the patient will not face any infectious complications.
Another option is errors when performing the injection. For example, a needle can scratch the periosteum or enter a nerve or vessel. But even here, if the doctor knows the anatomy and follows the technique of the procedure, this will not happen.
What requirements does the technique impose on the qualifications of a specialist giving injections into the joint?
A.S.:
Intra-articular injections can be given not only by orthopedists, but also by surgeons, rheumatologists and even sports doctors. Indeed, in sports, joints are subjected to particularly intense stress, and emergency assistance is often required.
The main requirements are higher medical education, practical training and excellent knowledge of anatomy.
The therapeutic effect is determined not only by the nature of administration, but also by the drug. Tell us, are there any specific drugs for injection specifically into the joints or are we talking about the same drugs for injection as usual?
A.S.:
Preparations for joints can be divided into several groups: local anesthetics, glucocorticoids, chondroprotectors, hyaluronic acid preparations, specific drugs such as platelet-rich plasma and ozonated solutions.
Injections of anesthetics to restore joints will not help, but they will quickly relieve pain for a while. They are often used not separately, but together with other drugs.
Glucocorticoids are anti-inflammatory drugs. The effect of their use lasts on average from 1 week to 1 month. But it is not recommended to do them more than 3–5 times a year on the same joint.
To restore cartilage tissue, intra-articular injections of chondroprotectors, blood plasma, and hyaluronic acid are given. Hyaluronic acid compounds are also called synovial prostheses. In terms of their viscosity and elasticity, they approximately correspond to the synovial fluid, which is normally found in the joint cavity and prevents its surfaces from abrasion.
I would especially like to note the treatment of joints using plasma therapy. In this case, the patient's plasma, enriched with platelets and devoid of other blood cells, is used for injections. It is injected into the joint itself and into the tissues surrounding it. Plasma contains a large amount of nutrients and biologically active substances. And platelets are concentrates of growth factors.
After such injections, symptoms do not just go away temporarily. Cartilage tissue begins to recover, inflammation decreases, and nutrition of the joint improves. The possibilities of plasma therapy are now being actively studied, but its effectiveness has already been proven in research and in real clinical practice.
The specific drug for intra-articular injections, of course, must be selected by the doctor, taking into account all the clinical data and the capabilities of the medical organization where the patient went.
Is this method available in public clinics?
A.S.:
Of course have. This is a standard treatment method in orthopedics. It is included in clinical guidelines for the treatment of osteoarthritis of the knee and hip joints and is described in the national orthopedic guidelines.
But you will need to ask in advance what kind of drugs are used in the medical institution. If you are interested in a specific medicine, you may have to order it or buy it elsewhere. And the injection can be done in the clinic.
At the first appointment with a doctor at a state clinic, I also advise you to clarify whether such treatment is included in the compulsory medical insurance system or is provided for a fee, what tests, referrals and other papers will be needed. This will avoid surprises.
How much will the service cost in a private clinic in Moscow?
A.S.:
This depends on the clinic’s pricing policy and on the affected joint. But to a greater extent - from the drug that will be administered. Glucocorticoids for intra-articular injections are inexpensive, about 300–700 rubles per ampoule. Plasma therapy for joints will cost an average of 7,000–8,000 rubles per procedure. But the cost of hyaluronic acid preparations can reach 13,000–14,000 rubles and more.
The cost of an intra-articular injection excluding the drug can vary from 1000 to 2500 rubles and more, depending on the pricing policy of the clinic and the type of joint. If the procedure is carried out under ultrasound or fluoroscopy control, then the cost of one injection of new generation chondroprotectors can be 2000–4000 rubles.
Andrey Sergeevich, thank you for such informative answers. I would like to wish you successful work and your patients a speedy recovery.
A.S.:
Thank you, good health to you!
Intra-articular injections are one of the methods for treating arthrosis and arthritis. Using injections, substances are delivered directly into the joint cavity that relieve inflammation and pain, stimulate the restoration of cartilage tissue, or serve as a replacement for synovial fluid. But only a doctor can select a specific drug, taking into account the results of the examination.
License No. LO-77-01-008730 dated August 6, 2014, issued by the Moscow Department of Health.
Sources:
1 Bodoev A.V. Experience in the treatment of gonarthrosis with injections of drugs through intra-articular puncture//A.V. Bodoev, B.B. Tushinov/Bulletin of the Buryat State University. 2015. No. 12. P.148-150
Price of intra-articular injections of hyaluronic acid at the Yuzhny clinic
The cost of the service depends on the pricing policy of the institution and the degree of damage to the joint. The cost of the administered drug plays a big role. Corticosteroid drugs are the most inexpensive, their cost ranges from 300 to 600 rubles per ampoule. Preparations containing hyaluronic acid are much more expensive, their cost ranges from 13 thousand rubles and more.
The cost of the injection itself, as a rule, does not exceed two thousand rubles. If necessary, the doctor can use additional tests, for example, ultrasound diagnostics or fluoroscopy, which is paid separately.
The price of intra-articular injections of hyaluronic acid at the Yuzhny clinic varies depending on the number of procedures required, the stage of the disease and the concentration of the drug, which is selected by a specialist individually in each case.