Orthopedic Injections that can Improve your Quality of Life
Michael Harper MD, Interventional Sports Medicine Physician
Joint pain, nerve pain, and tendon injuries. All three are common orthopedic conditions that millions of people encounter at some point in their life. When it is time to seek treatment, it is not unusual to start by considering non-operative treatments. Non-operative treatments are more cost effective, less invasive, and provide rapid recovery.
In fact, our orthopedic surgeons at OSMS perform surgery on less than 30% of our patients because they see the value in conservative treatment options for patients. Common non-surgical treatments include activity modification, physical therapy, exercises to optimize mechanics, medication, bracing, image-guided injections, or regenerative medicine.
Orthopedic injections are one of the most popular forms of non-surgical treatments for orthopedic and sports medicine injuries because they can have both diagnostic and therapeutic value. The majority of the injections utilize a local anesthetic, which can be helpful to determine the structure that is causing pain. The various medications then can be therapeutic in treating the pathology at that location. The primary goal of an injection is to be able to help improve somebody’s pain, improve their function, and ultimately improve their quality of life.
Some of the most common orthopedic injections include corticosteroid injections, hyaluronic acid injections, and platelet-rich plasma (PRP) injections.
Corticosteroids (Cortisone Injections or Cortisone Shots)
What are corticosteroids?
These are powerful anti-inflammatory medications, often injected directly into the affected area.
Where are they used?
They’re commonly used for joint pain (various forms of arthritis), tendon problems, and nerve issues. Examples include knee osteoarthritis, tennis elbow and carpal tunnel syndrome.
What does a cortisone shot do?
Corticosteroids reduce swelling, pain, and inflammation quickly. This can help patients feel better in the short term, especially for conditions like arthritis or tendonitis. However, they shouldn’t be used too often, as long-term use may weaken tissues. Another consideration is if a patient has high blood pressure and diabetes as steroids can temporarily increase blood sugar and blood pressure.
How quickly does it take for a cortisone shot to work?
Steroid injections can take 3-5 days to take effect, but some patients are later responders, and it can take up to 2 weeks.
How often are they administered?
Steroid injections can be performed in a 3-month time interval. However, you should discuss with your doctor what they recommend for the timing and frequency of steroid injections. Personally, I highly recommend having steroid injections performed 3 times or less per year.
Hyaluronic Acid
What is hyaluronic acid?
Hyaluronic acid is a substance naturally found in the joints, where it acts like a cushion and lubricant. Injections of hyaluronic acid can help restore this cushioning effect.
Where is it used?
Hyaluronic acid is mostly for joint problems, particularly in the knee for osteoarthritis; however, it can also be used in other joints. These injections tend to last around 6 months, and most insurances cover them every 6 months.
What does a hyaluronic acid injection do?
Hyaluronic acid injections help improve joint lubrication, reduce pain, and allow for smoother movement. I like to think of it as an oil change for the joint. It is a good option for people with mild to moderate arthritis when other treatments haven’t worked. Additionally, we have not seen the same weakening effect in the tissues as we do in steroids.
How quickly does it take for hyaluronic acid injections to work?
Hyaluronic acid injections tend to take a few weeks to see benefit, but some patients notice a difference in the first few days.
How often are they administered?
Hyaluronic injections are typically done at a 6-month interval.
Platelet-Rich Plasma (PRP Injections)
What are PRP injections?
Platelet rich plasma (PRP) injections are the workhorse of Regenerative Medicine and Orthobiologics. It is made by taking your own blood, processing it to concentrate the platelets, and then injecting it into the damaged area. Platelets contain growth factors that promote healing and optimize inflammation. Not all locations treating with PRP are using the same protocols. Recent data shows that higher concentration and total number of platelets have higher success rates. This can be obtained by taking a larger volume of blood and utilizing a double spin centrifuge, both of which we do at OSMS.
Where is it used?
It can be used in joints, tendons, and sometimes around nerves. It’s often used for tendon injuries and joint pain in the shoulder, elbow, knee, hip, and ankle.
What do PRP injections do?
PRP helps to speed up healing by promoting tissue repair and reducing inflammation. It’s often used for tendon injuries that haven’t responded well to other treatments or for chronic joint pain. We have not seen that PRP will regrow cartilage, but it can help with managing symptoms of arthritis and optimize inflammation. Recent data on PRP injections show that the effect can be longer than steroids and hyaluronic acid for knee osteoarthritis. We are seeing that inflammatory markers can be reduced after PRP. Additionally, we have not seen the same weakening effect in the tissues as we do in steroids. Recent studies have also suggested it may slow the progression of knee osteoarthritis.
How quickly does it take for PRP injections to work?
PRP for the tendon takes weeks to allow for tendon healing. I tell patients that they may start to notice some improvement in the first 6 weeks, but it is typical for the benefit to be seen between 6 and 12 weeks.
How often are they administered?
The timing and frequency of PRP injections is actively being researched. Some protocols have one injection performed and others have a series of injections. Repeat PRP injections are individualized based on the response to the prior injection. Generally, PRP injections can be repeated every 6 months to a year, but in some situations, it can be done sooner.
What about Stem Cell injections?
Bone marrow aspirate concentrate (BMAC), and microfragmented adipose tissue (fat cells) have been marketed as stem cells. Although there is a role for these treatments in some patients, most orthopedic conditions do not require these treatments. Recent data also indicates that they may not be any more effective than PRP for conditions such as knee osteoarthritis. Given the current data, out of pocket cost and discomfort of harvesting bone marrow and fat cells, we typically recommend trialing PRP over the other cell mediated procedures like BMAC and fat cells.
PRP Injection Cost and Insurance
Since PRP Injections are not covered by insurance, we encourage patients to talk with one of our Patient Advocates or someone in our Business Office about your payment options. Oftentimes, our patients utilize HSA or FSA funds.
To contact our Patient Advocates, call our main line 920-430-8113 and ask to speak with a Patient Advocate.
Contact the OSMS Business Office at: 920-430-8120
For those seeking non-operative treatment for pain, an orthopedic injection may be for you. If this is something you are interested in learning more about, schedule an appointment with one of our orthopedic physicians! We would be happy to evaluate your injury or pain and discuss what treatment options or injections may be right for you.
