INJECTION THERAPIES
Injection Therapies in Orthopaedics are commonly used for both diagnostic and therapeutic purposes. They can help reduce inflammation, relieve pain, promote healing, and improve joint or soft tissue function.
🔹 Types of Injection Therapies in Orthopaedics
1. Corticosteroid Injections
Indications:
Osteoarthritis (e.g. knee, shoulder)
Bursitis (e.g. subacromial, trochanteric)
Tendinitis/Tendinopathies (e.g. rotator cuff, tennis elbow)
Inflammatory arthritis
Mechanism: Potent anti-inflammatory effect
Common Drugs: Triamcinolone, Methylprednisolone, Dexamethasone
Limitations: Limited frequency (risk of tissue damage), potential systemic effects (e.g. hyperglycemia)
2. Viscosupplementation (Hyaluronic Acid Injections)
Indications: Knee osteoarthritis (main use)
Mechanism: Lubricates the joint, improves shock absorption
Effectiveness: Variable; more effective in early-stage OA
Example: Synvisc, Orthovisc, Hyalgan
3. Platelet-Rich Plasma (PRP) Injections
Indications:
Tendinopathies (e.g. tennis elbow, Achilles tendinitis)
Early osteoarthritis
Muscle and ligament injuries
Mechanism: Uses patient’s own blood components to promote healing
Pros: Autologous, lower risk of reaction
Limitations: High variability in efficacy; expensive
4. Stem Cell Therapy (Mesenchymal Stem Cells)
Indications: Under investigation for cartilage repair, OA, tendon injuries
Mechanism: Regenerative potential
Status: Still mostly experimental; limited clinical approval
5. Local Anesthetic Injections
Indications: Diagnostic use in pain localization; short-term relief
Drugs: Lidocaine, Bupivacaine
Used With: Often combined with corticosteroids
6. Botulinum Toxin (Botox)
Indications: Spasticity, chronic pain conditions (off-label in some cases)
Mechanism: Blocks acetylcholine at neuromuscular junction
7. Prolotherapy
Indications: Chronic ligament/tendon pain
Mechanism: Injection of irritant (e.g. dextrose) to promote healing response
Controversial: Limited high-quality evidence
🔹 Common Sites for Injections
Shoulder: Subacromial bursa, glenohumeral joint, AC joint
Knee: Intra-articular space
Hip: Trochanteric bursa, intra-articular
Spine: Facet joints, epidural space
Foot/Ankle: Plantar fascia, tibiotalar joint
Elbow/Wrist: Lateral epicondyle, carpal tunnel
🔹 Risks and Complications
Infection
Post-injection flare
Skin depigmentation or atrophy (especially with steroids)
Tendon rupture (if injected into tendon)
Nerve injury