Michael Harper MD, Interventional Sports Medicine Physician

So, you have an injury or pain in your joint, tendon, or nerve. Where do you start? In many cases, these injuries or conditions can be treated non-operatively, or without surgical intervention. If it is decided that your injury is not severe enough to need surgery, then here are some of your options. Common non-surgical treatments include activity modification, physical therapy, exercises to optimize mechanics, medication, bracing, image-guided injections, or regenerative medicine.

How Joint, Tendon, and Nerve Injections Can Help with Pain

Orthopedic injections can be used to treat your joint, tendon, or nerve pain. Each injection type has specific benefits. The choice of which injection to use depends on the condition being treated for an individual. Injections can help manage pain, reduce inflammation, and promote healing in joints, tendons, and sometimes nerves.

Key Differences in Injection Treatment Areas:

Joint Injections:

Corticosteroids, hyaluronic acid, and platelet-rich plasma (PRP) are often used for joint pain, especially from arthritis. While corticosteroids help with inflammation, hyaluronic acid helps with lubrication, and PRP promotes healing and regeneration of damaged tissues and optimizing inflammation. In some instances, PRP and hyaluronic acid injections are used during the same injection to optimize both effects.

Tendon Injections:

For tendon injuries (like tendonitis or tendinosis), PRP is a common choice because it stimulates healing. Corticosteroids might be used for short-term relief but can weaken the tendon if overused.

Nerve Injections:

These aren’t as common, but corticosteroids can help with nerve pain, especially if there’s inflammation around the nerve, like with sciatica or carpal tunnel syndrome. Recent studies are showing there is also a role for PRP in treatment of nerve conditions, but research is still on-going.

Types of Joint, Tendon, and Nerve Injections:

Types of Joint Injections for Arthritis and Pain Relief:

• Steroid Joint Injections
• Hyaluronic Acid Joint Injections
• Platelet Rich Plasma (PRP) Joint Injections
• Orthobiologic Joint injection
• Regenerative Medicine Joint Injection
• Shoulder Joint Injection
• Hip Joint Injection
• Knee Joint Injection
• Ankle Joint Injection
• Hand Joint Injection
• Subacromial Bursae Injection
• Greater Trochanteric Bursae Injection

Types of Tendon Injections for Pain Relief:

• Tennis Elbow Injection
  • Lateral Epicondylitis Injection
• Biceps Tendon Injection
• Iliopsoas Tendon Injection
• Calcific Rotator Cuff Injection

Types of Nerve Injections for Pain Relief:

• Nerve Block Injection
• Carpal Tunnel Injection
  • Median Nerve
• Cubital Tunnel Injection
  • Ulnar Nerve
• Lateral Femoral Cutaneous Nerve Injection
• Tarsal Tunnel Injection
• Suprascapular Nerve Block
• Genicular Nerve Block

If you have any questions about these injections, schedule an appointment with one of our orthopedic physicians to learn more.

Exploring Differences in Three Common Injections:

What are corticosteroids?

These are powerful anti-inflammatory medications, often injected directly into the affected area.

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.

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.

For more information about the Orthopedic Injections above, read our blog: Orthopedic Injections that can Improve your Quality of Life

How to Choose the Right Orthopedic Injection:

Choosing the right orthopedic injection begins with an accurate and thorough diagnosis of the specific condition or injury. It’s essential to identify the underlying cause of pain or inflammation. Your provider needs to identify whether it’s arthritis, tendonitis, bursitis, carpal tunnel or another issue since different injections target different conditions.

For example, corticosteroid injections are commonly used for a variety of conditions to reduce inflammation and provide pain relief, while hyaluronic acid injections are helpful for osteoarthritis. Platelet-rich plasma (PRP) and orthobiologic injections are considered for promoting healing in certain musculoskeletal injuries and optimizing inflammatory environments.

The correct diagnosis ensures that the injection chosen will effectively address the problem, while the right medication will provide the best chance of relief and long-term improvement.

Concerns, Risks, and Side Effects of Orthopedic Injections

Common Concerns and Potential Side Effects of Joint Injections:

Concerns:

• Infection: Any injection carries a risk of infection, though it’s rare if done under sterile conditions.
• Pain at Injection Site: Some discomfort or soreness after the injection is common, especially within the first 24-48 hours.
• Cartilage Damage: Long-term or frequent use of corticosteroid injections can potentially lead to cartilage breakdown in the joint. We do not see this in hyaluronic acid or PRP injections
• Reduced Immune Function: Corticosteroid injections can suppress the immune system for a short period, increasing the risk of infections.

Potential Side Effects of a Steroid Injection:

• Skin Discoloration: A temporary change in skin color around the injection site.
• Elevated Blood Sugar: Steroid injections can increase blood sugar levels, especially in diabetic patients.
• Fat Atrophy: Fat tissue at the injection site can shrink or thin out over time, creating an indentation or cosmetic changes.
• Joint Weakening: Repeated corticosteroid injections may cause a weakening of the joint structures over time.

Common Concerns and Potential Side Effects of Tendon Injections:

Concerns:

• Tendon Rupture: Steroid injections in tendons carry a small risk of tendon rupture or thinning, especially with repeated use.
• Infection: As mentioned above, with any injection, there’s always a risk of infection. However, it’s rare if done under sterile conditions.
• Pain and Swelling: Tendon injections may cause temporary swelling or discomfort in the first few days after the injection.
• Reduced Healing: Steroid injections may slow the natural healing process of the tendon if used too frequently. PRP may have the opposite effect and promote a healing environment.

Potential Side Effects:

• Tendon Weakening: Corticosteroids can weaken the tendon structure over time, potentially increasing the risk of re-injury.
• Skin Changes: As with joint injections, there may be skin thinning or discoloration at the injection site after a steroid injection.
• Temporary Flare-Up of Pain: Some people experience a short-term increase in pain after the injection before feeling relief.

Common Concerns and Potential Side Effects of Nerve Injections:

Concerns:

• Nerve Damage: There’s a slight risk of damaging the nerve or surrounding structures during the injection. Image guidance (ultrasound) to assist the placement of the injection can help avoid nerve injury.
• Infection: As with all injections, there’s a risk of introducing infection. However, it’s rare if done under sterile conditions.
• Temporary Increase in Pain: Nerve injections may cause a temporary increase in pain or discomfort before providing long-term relief.
• Localized Nerve Effects: Numbness or tingling may occur, particularly if the nerve is temporarily blocked or affected by the medication.

Potential Side Effects:

• Similar to the above side effects for steroids
  • Skin Discoloration: A temporary change in skin color around the injection site.
  • Elevated Blood Sugar: Steroid injections can increase blood sugar levels, especially in diabetic patients.
  • Fat Atrophy: Fat tissue at the injection site can shrink or thin out over time, creating an indentation or cosmetic changes.
  • Weakness or Paralysis: Nerve injections may result in temporary muscle weakness or a feeling of paralysis in the area affected by the nerve block.

Injections are a non-surgical treatment option that are usually just part of a broader treatment plan. This plan may include additional non-operative treatment options such as physical therapy and lifestyle changes. Always talk with your doctor to figure out the best option(s) for your unique situation.

If you have any questions about non-surgical treatment options, or would like to be evaluated for non-surgical treatment options, give our office a call at (920)-430-8113 or schedule an appointment at: Schedule An Appointment – OSMS