Injections may be an option to treat or relieve orthopedic pain when you don’t need surgery in the short term or you have a condition that can get better without surgery.
“If a patient has a condition that can be managed with non-operative treatment, their success and healing often depends on physical therapy or a home exercise program for rehabilitation. I may be able to offer injections as a way to facilitate that process and make it easier,” said Dr. Matthew Spivey at Novant Health Orthopedics & Sports Medicine - Clemmons, who specializes in orthopedic sports medicine for shoulders, knees and hips.
Simply put: Injections can offer pain relief so you can be more productive with physical therapy or rehab.
Spivey discusses three main orthopedic injections to know about.
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1. Steroid injections
How it works: Known technically as corticosteroid injections, this involves a type of steroid that acts as an anti-inflammatory agent. Anti-inflammatory medications taken by mouth like ibuprofen get absorbed and provide pain relief all through the body. With a steroid injection, we put an anti-inflammatory at the location where we think the pain is coming from. That can be more effective, more quickly – and it often is longer-lasting than a pill that you have to take multiple times a day, every day.
Of the injection options, steroid injections are probably the most commonly used due to their accessibility and effectiveness for many conditions. They can provide near-immediate relief in many patients. Your doctor may call these cortisone injections as well.
Effects: The effects of steroid injections can last several months. For folks with an injury or a problem causing them significant pain in a joint, doing injections once or twice for a short-term reason can clear the way for physical therapy.
Concerns: One common concern with steroid injections is the risk of frequent or repetitive steroid exposure. Side effects that are possible with increasing injection frequency can include cartilage damage, thinning or softening of the bone around a joint, skin color changes in a small area where injections are performed, and tendon weakening.
Accelerated onset of arthritis can be a concern for younger patients as well. If we were to do multiple steroid injections per year in one young person’s knee in their 20s over a long period of time, for example, this could lead to arthritis sooner in the joint over time.
But for older patients, steroid injections can help defer the surgical replacement of a knee, hip or shoulder. At this point in their life, the patient may be less concerned about earlier onset of arthritis. It’s already happening, and what we’ve been doing up to now isn’t working, and the alternative is a big surgery the patient is not ready for yet.
Insurance: If deemed medically necessary, corticosteroid injections are usually covered by insurance.
2. Gel hyaluronic acid injections, also called viscosupplementation
How it works: These injections most commonly target the knee and feature hyaluronic acid, which is a naturally occurring substance that exists around the joints. The goal is to put a lubricant type of substance into the joint to relieve pain and the clicking, popping and catching that happens with advancing arthritic changes in the joint. It seems to work best in the moderate to advancing type of arthritis. This type of injection can help if a patient is not ready for a knee replacement, or if cortisone shots are not providing relief.
They sometimes require a greater frequency of injection at the start. One common approach is administering a series of three injections, such as once a week for three weeks to build up the volume of the supplement in the affected joint.
Effects: The effects of the injection can last for several months, depending on the individual and the degree of arthritis in the joint.
Concerns: It can take a few weeks to notice improvements in pain.
Insurance: In general, patients need some form of pre-approval from their insurance company to cover this type of injection. The injections are not yet approved by the Food and Drug Administration for osteoarthritis in the shoulder, so they are usually not covered by insurance.
3. Platelet-rich plasma (PRP) injections
How it works: The goal of PRP injections is to stimulate healing. A concentration of the patient’s platelets (blood cells with healing properties) is used to create platelet-rich plasma, which is then injected into the injured area to help promote a healing response in the body.
Effects: Because of the way it works, PRP injections might cause some soreness before you see improvement because it stimulates inflammation – an inflammatory response is the body’s way of healing.
But while the pain relief from corticosteroid or hyaluronic acid injections eventually wears off in the body, in some situations PRP has the potential to create a longer-lasting healing effect than the other two injections.
Concerns: PRP injections are a subject of ongoing research to optimize the effect of the treatment and to determine what medical conditions they are most appropriate for. While PRP is a newer treatment, there are promising results in conditions like tendonitis, muscle strains or tears, or certain stages of arthritis. It is also sometimes used to augment surgical repairs or reconstructions.
Insurance: Don’t expect non-surgery-related PRP injections to be covered by insurance. The cost can vary widely. Ask your doctor’s office about the price.
Curious about injections for an orthopedic condition? Talk to an orthopedic surgeon.
A specialist can clarify when injections, or certain injections, are, or are not, a good option for you. For example, if you may decide to undergo surgery, an injection close to that date can increase the risk of infection with surgery. Another example: Steroidal injections can be a concern for people with diabetes because they can temporarily increase blood sugar levels.
A specialist can also educate you about injections that could support recovery through physical therapy, or even healing. There are so many different situations and rationales for doing them.
If your primary care physician has suggested you see a specialist, it’s worth going and discussing your options to understand whether injections might be helpful in your situation.
