When Should I Call The Doctor
You should call your healthcare provider if you experience:
- Signs of infection, such as fever, redness or yellow discharge at the injection site.
- Severe pain in the treatment area.
- Severe bruising or bleeding.
A note from Cleveland Clinic
Bursa injections are an effective treatment for bursitis pain and inflammation. They are commonly combined with rehabilitation, depending on the body area. Generally, one injection can decrease your pain significantly. However, to keep bursitis from recurring, its important to follow your healthcare providers advice. You may need to limit activities that irritate the joint or wear a supportive brace or sling. Stretching and strengthening exercises may also help. If your symptoms reoccurred after your joint injection, please discuss them with your healthcare provider. Commonly, inflammation also involves the tendon because its close to the bursa in several joints. Your provider may recommend other therapies or surgery if injections havent been successful.
Last reviewed by a Cleveland Clinic medical professional on 07/21/2021.
References
Prp Injection Represents A Valid Conservative Treatment To Reduce Pain Improve Quality Of Life And Functional Scores Even At Midterm Of 6 Months Follow
A May 2022 paper published in the Journal of clinical medicine evaluated the Platelet Rich Plasma injections for safety and effectiveness in patients affected by knee osteoarthritis. The researchers noted that PRP has shown promising results in achieving pain reduction and better function in these patients.
In this study, one hundred and fifty-three patients from 40-81 years old received three consecutive PRP injections. The patients were then followed up to determine if the treatment helped them. The patients were evaluated before PRP injection, at one month, three months and six months after the treatment.
Results: A statistically significant functional ability and pain reduction was seen during the course of the study. While MRI demonstrated non-statistically significant improvement in cartilage thickness for both tibial plate and femoral plate and no radiographic changes could be seen in any patients.
Research Reduced Pain And Increased Function But Prp Did Not Confer Superiority When Assessing Knee
A May 2022 study from the Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, published in The Journal of arthroplasty questioned why PRP use continues to rise, despite guidelines suggesting non-superiority to comparative . To seek this answer the researchers performed a systematic review and meta-analysis on PRP efficacy using two clinical assessments: Visual Analog Scale and Western Ontario and McMaster Universities Osteoarthritis Index. . They then compared PRP to similar groups using hyaluronic acid corticosteroid normal saline and exercise therapy.
Results: PRP led to Visual Analog Scale and Western Ontario and McMaster Universities Osteoarthritis Index improvements in most studies when compared to hyaluronic acid, corticosteroid, and normal saline. Comparison to exercise therapy resulted in inconclusive findings. No differences were found when assessing structural changes or cartilage thickness by magnetic resonance imaging. Conclusions: PRP may be associated with pain and functional improvements but was not clinically relevant . In addition, PRP did not confer superiority when assessing knee-related structural changes.
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Cortisone Injections Five Years Later Did They Make Knees Worse Not Sure Maybe No
When it comes to corticosteroid injections numerous research studies, as documented here, will be in contradiction of each other. Lets look at a March 2022 paper in the journal Arthritis & Rheumatology. Here the researchers write:
- Recent findings found intra-articular corticosteroid injections to cause harmful effects on knees with osteoarthritis.
- This research sought to assess in a real-life setting the risk of knee osteoarthritis progression in patients who received intra-articular corticosteroid injections over a 5-year follow-up.
Among the 564 patients with knee osteoarthritis included in this study, 51 and 99 received intra-articular corticosteroids or intra-articular hyaluronan injections, respectively, and 414 did not receive any injection during follow-up.
- Compared with untreated knees, those treated with intra-articular corticosteroid injections had a similar risk of incident needing a total knee replacement or osteoarthritis worsening. Intra-articular hyaluronan injections had no effect on the risk of total knee replacement or osteoarthritis worsening.
In other words the researchers suggest that they found no significant side effects but they remind others to interpret these findings cautiously.
Corticosteroid Injections Can Help Relieve Both Inflammatory Arthritis And Osteoarthritis Find Out More If Theyre A Good Pain Relief Option For You
Remember the Carly Simon song I Havent Got Time for the Pain? She may have been talking about heartbreak, but arthritis pain is something you dont want to make time for either. When you have osteoarthritis or a type of inflammatory arthritis, such as rheumatoid arthritis or gout, you may get used to living with daily chronic pain, but when an acute arthritis flare occurs, it can really throw you off your daily routine and ability to work, be active, run errands, etc. Thats where corticosteroid injections come in a treatment option for acute bouts of pain.
Before Cheryl Ackerman was diagnosed with rheumatoid arthritis, she was experiencing pain so excruciating that she could barely walk, sit, or stand for any length of time. Per a doctors recommendation, she received corticosteroid shots in both of her knees, neck, and back. After about three weeks I finally felt the full effect by the inflammation going down and this gave me great relief, says Ackerman, who is from Florida. Even with the maintenance and pain, Ackerman says getting the injections is worth it. They have improved my quality of life living with rheumatoid arthritis immensely.
Steroid injections can relieve pain and improve mobility for many people, but they dont work equally well for all types of arthritis. There are also important precautions about how frequently you can safely receive them. Heres what you need to know before you face the needle.
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Knee Pain Treatments Depend On Severity Of Pain And Damage
Knee pain can take many forms. It may be a sharp pain, achiness, a dull burning sensation, or uncomfortable swelling or stiffness. The pain may be worse at night, and the knee may feel unstable.
About one in four Americans lives with chronic knee pain that limits their function and mobility and interferes with their quality of life. The most common cause of knee pain? Osteoarthritis. In this progressive form of arthritis, the cartilage that cushions the ends of the bones in the knee joint wears away over time.
Knee pain treatments depend on the severity of the pain and how advanced the damage is. Mild pain may be managed with over-the-counter, non-steroidal anti-inflammatory drugs , such as ibuprofen or naproxen , along with physical therapy or a supportive knee brace. More significant pain may require medical treatment, especially if it affects your work, exercise or everyday activities.
Types of knee injections for pain
If more conservative treatments arent effective, your doctor may recommend injections to relieve discomfort and restore your normal function.
There are several types of injections to reduce inflammation in the knee joint, which can help with pain and mobility for several months or more, says Jeffrey Wilde, MD, an orthopedic surgeon with Scripps Clinic. The right choice is determined by your symptoms and your individual medical profile.
Corticosteroids
Hyaluronic acid injections
Platelet-rich plasma injections
Knee replacement surgery
Related tags:
What If Knee Injections Dont Work
Knee replacement would be the last step in the treatment process for a patient with knee arthritis. However, this should only come after the patient has tried and failed with injections, bracing, NSAIDs, use of cane/walker, and most importantly a formal physical therapy program to maximize strength, motion, and weight loss, if necessary. When these treatments dont work, or stop working, then the patients options are to live with their current symptoms, or to proceed with knee replacement.
Knee replacement is the only thing that changes what the x-ray looks like and truly gets rid of the arthritis. All of the other treatments control the symptoms. The knee replacement is an open surgery where the ends of the femur and tibia, where the damaged cartilage is, are removed and metal caps are placed on the ends of the bone with a polyethylene spacer in between. This becomes the new knee joint. Patients nowadays typically go home the same day and are walking, with assistance, the day of surgery. Physical therapy ensues and patients typically recover in about 3 months. Knee replacement is a beneficial operation in the right candidate with typically 85-90% excellent outcomes.
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What Should I Know About Cortisone Shots
A cortisone shot is a temporary solution to your knee pain. Its just one treatment in an overall plan to bring your joint back to health. It doesnt stop arthritis progression. At the appropriate time, your doctor likely recommends physical therapy to strengthen the muscles around the knees and help you regain mobility.
If you have mild or moderate arthritis, the shots effect can last three months or longer. Youre limited to having a cortisone shot in your knee to four times a year. Too much cortisone can worsen the damage to your knee joint. If its time for a partial or full knee replacement, a cortisone shot can ease your pain and allow you time to prepare for the surgery.
Repeated Courses Of Treatment With Hyaluronic Acid Are Safe And Are Associated With The Delay Of Total Knee Replacement For Up To 3 Years
A July 2018 study in the American Journal of Orthopedics recognized that for some people: Total knee replacement is a significant procedure with potential risk for serious complications and high costs. Alternative lower risk therapies that can delay or total knee replacement are valuable to those who are poor candidates for surgery or wish to avoid total knee replacement as long as possible.
Are Hyaluronic Acid Injections the answer? Here is what the study concluded:Repeated courses of treatment with Hyaluronic Acid are safe and are associated with the delay of total knee replacement for up to 3 years. So again, we have a three-year delay after repeated courses of Hyaluronic Acid injections supported in the research. But what about the study that says Hyaluronic Acid Injections that delay inevitable knee replacement are a waste of time, money, and resources?
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How Do These Knee Osteoarthritis Injections Work
Normal joint fluid contains a substance called hyaluronan. It acts like a shock absorber and lubricant in your joint and is needed to help the joint work properly. Hyaluronan is highly viscous, allowing the cartilage surfaces of the bones to glide upon each other smoothly. This leads to decreased symptoms of osteoarthritis.
How Does Prp Compare To Ozone Therapy In Helping Knee Pain
In research from February 2017, Turkish researchers published in the medical journal Knee Surgery, Sports Traumatology, Arthroscopy compared treatment effectiveness in patients with knee osteoarthritis given an intra-articular injection of platelet-rich plasma, hyaluronic acid, or ozone gas.
A total of 102 patients with mild-moderate and moderate knee osteoarthritis were chosen who had at least a 1-year history of knee moderate pain
- Group 1 received an intra-articular injection of PRP × 2 doses,
- Group 2 received a single dose of hyaluronic acid,
- and Group 3 received ozone × four doses.
- At the end of the 1st month after injection, significant improvements were seen in all groups.
- In the 3rd month, the improvements were similar in the Platelet-Rich Plasma group and hyaluronic acid group, while those in the ozone group were lower.
- At the 6th month, while the clinical efficacies of Platelet-Rich Plasma and hyaluronic acid were similar and continued, the clinical effect of ozone had disappeared
- At the end of the 12th month, Platelet-Rich Plasma was determined to be both statistically and clinically superior to hyaluronic acid.
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In This Video Ross Hauser Md Explains How One Injection Of Prp Will Likely Not Work
A transcript summary is below the video
We will often get emails from people who had previous PRP therapy without the desired healing effects. We explain to these people that their treatment probably did not work because the single PRP injection did not resolve knee instability. The PRP may have tried to create a patch in the meniscus or cartilage to help with a bone-on-bone situation but the instability and the wear and tear grinding down the meniscus and cartilage remain.
When a person has a ligament injury or instability, the knee becomes hypermobile causing degenerative wear and tear on the meniscus and knee cartilage. In other words, the cells of the meniscus and cartilage are being crushed to death. When you inject PRP cells into the knee, without addressing the knee instability, the injected PRP cells will also be subjected to the crushing hypermobile action of the knee. The single injection PRP treatment will not work for many people. The knee instability needs to be addressed with comprehensive Prolotherapy around the joint. Prolotherapy is the companion injection of simple dextrose. This is explained in detail below.
Runaway Chronic Inflammation Destroys The Extracellular Matrix In The Osteoarthritic Knee
Lets stop here to discuss the part about recruiting local stem cells
One of the most fascinating parts of our bodies healing components is the extracellular matrix . What is the extracellular matrix? Chondrocytes are cells that are the building blocks of cartilage. Our body calls chondrocytes to the area of the knee that is damaged and needs to be fixed. Once there the chondrocytes place themselves into the hole in the cartilage and then once it plants itself there, it secretes its extracellular matrix as a glue to hold itself in place.
In reviewing the work of Italian researchers on the effectiveness of Platelet Rich Plasma in early-stage knee osteoarthritis that appeared in the May 2017 edition of the medical journal Joint, we came across a great paragraph that describes how when the extracellular matrix is diluted by inflammation-causing the cartilage bricks to fall out of the hole it is trying to patch.
Osteoarthritis is not related to only mechanical stress , but many cellular and biochemical processes are also involved in its pathogenesis. In normal conditions, the cartilage extracellular matrix is in a dynamic equilibrium. In particular, the balance between the anabolic and catabolic activities of chondrocytes maintains the structural and functional integrity of cartilage. In osteoarthritis, a deregulated balance between proteinases degrading the extracellular matrix and their inhibitors may be responsible for cartilage degeneration.
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How Many Steroid Injections Can I Have
At Complete we have been carrying out steroid injections for over ten years. Steroid injections are extremely effective for reducing pain, improving function, and returning people back to their desired sport as soon as possible.
One of the most common questions we get regarding steroid injections is how many steroid injections can I have? There is no simple answer to this as it depends on the individual presentation of the case.
A majority of injections we carry out at Complete are a one off and do not require repeat injections. However, if you have an arthritic joint for example osteoarthritis in the knee or base of the thumb then repeat injections may be required. The NHS suggests that you have no more than three injections per year and they should be at least 6 weeks between injections .
If you have arthritis and we feel you may require multiple injections then we often use a substance called hyaluronic acid. Most commonly we use it for knee joint arthritis as this is the joint where a majority of the research has been carried out. Hyaluronic acid is a lubricant and is not classified as a drug and so has very few side effects.
The NHS suggests that you have no more than three injections per year and they should be at least 6 weeks between injections
Cortisone Can Make Bone On Bone Worse By Thinning Out The Meniscus But One Injection Appears Okay
One of the reasons that you are considering a knee replacement or are thinking about getting a cortisone injection is because you have been told you have a bone-on-bone knee. So the idea that cortisone may make this worse by thinning out your meniscus is concerning doctors.
In August of 2020 in the journal Scientific Reports doctors expressed concerns about damaging the meniscus tissue with cortisone injections. It should be noted that this researchs main findings were that it was okay to get one cortisone injection. For many people, one injection would be considered safe. Here are the learning points of that research:
- Although intra-articular corticosteroid injections are commonly used for the treatment of knee osteoarthritis, there is controversy regarding possible side effects on the knee joint structure.
- In this study, the effects of intra-articular corticosteroid injections on worsening the knee structure and creating greater pain were examined.
- Findings: No significant effect of the intra-articular corticosteroid injections were found on the rate of cartilage loss nor on any other knee structural changes or patient-reported pain scores. In conclusion, a single intra-articular corticosteroid injection for the treatment of osteoarthritis-related knee pain was shown to be safe with no negative impact on structural changes, but there was a transient meniscal thickness reduction, a phenomenon for which the clinical relevance is at present unknown.
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How Long Does The Pain Relief From A Cortisone Shot Last
For some patients, cortisone shots can bring immediate pain relief for others, it can take a few days after the injection to start feeling improvements. According to Dr. Schaefer at the Cleveland Clinic, it can take up to a week for the cortisone to take effect. For others, the shots dont seem to have a big impact on pain and other symptoms. The duration of time for which the shots can bring relief varies tremendously. For some patients, they only work for a few months for others, a single injection can provide relief for a year or longer.