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