Other Injections: Hyaluronic Acid Botox And More
Some people have used other types of injections for OA of the knee.
However, experts from the American College of Rheumatology and the Arthritis Foundation dont currently recommend using these, as theres not enough evidence that they work.
Examples of other types of injections include:
- hyaluronic acid injections, also known as viscosupplementation
You may not know exactly what type of injection youre receiving or what the effect might be.
Always discuss the pros and cons of any treatment with your doctor before starting, so that you can make an informed decision.
Frequency Of Cortisone Shots
You may request for a cortisone injection if your joint pain returns after a few months or week. Typically, patients are restricted from getting more than 3 cortisone shots in a year. With that said, you should speak with your doctor regarding your particular situation. They will be able to explain your options and the best treatment combinations that would work in your condition.
A Positive Effect On Joint Pain May Also Be Associated With Accelerated Joint Destruction
This is what research says about it:
- Research: Cortisone works well for some but not for others and no one seems to be able to identify why:
- From the journal Seminars in Arthritis & Rheumatism: Previous research has not identified reliable predictors of response to intraarticular corticosteroid injections, a widely practiced intervention in knee and hip osteoarthritis. Further studies are required if this question is to be answered.
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What To Do In The Days After Getting A Cortisone Injection
Your doctor may ask you to protect the area where you were injected for a day or two, so as not to further exacerbate any pain. You may also be advised to ice the area heat is not recommended.
Although uncommon, its good to keep an eye out for any signs of infection including redness, swelling, or an increase in pain in the area that lasts for more than 48 hours.
If you experience any such symptoms, contact your doctor immediately.
When the pain starts subsiding is when you should jump into the long-term treatment plan to reap the most benefits.
How Often Can You Get Cortisone Injections
Depending on the condition being treated and where the injection is given, you may receive injections as frequently as every month. For other conditions, doctors may advise that you only receive a few injections within one year.
Professional athletes sometimes get injections throughout their season, but this should only be done with careful consideration and discussions with an orthopaedic sports specialist and an athletic trainer, she says.
But for the weekend warriors or those who want to type, knit, or play a piano pain-free, constant injections are likely not needed.
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Do Cortisone Injections Damage Joints
A recent study suggested that frequent cortisone injections harm knee cartilage. However, the people in this study had eight injections over two years. Generally, we think that 1-2 injections of cortisone are safe and effective in reducing pain and swelling in knee arthritis. But repeated injections into one joint can increase the risk of damage.
Prolotherapy Brings Oxygen To The Joint To Help Provide Healing Cells Energy And A Clean Safe Work Environment
In a 2017 stem cell study Dr. Ming Pei of West Virginia University publishing in the medical journal Biomaterials suggests that while adult stem cells are a promising cell source for cartilage regeneration, they have a hard time in a harsh joint environment when hypoxia and inflammation have created a toxic soup for the stem cells to work in. As noted above healing cells, like your native stem cells, like a clean, safe work environment. Chronic inflammation slowly and steadily brings about a low oxygen environment in joints because the body feels that diseased tissue will die in a low oxygen environment. Oxygen deprivation is designed to be a short-term drastic measure to healing a wound. But chronic inflammation means a slow strangulation of the joint
Sometimes we forget the cells of the body obtain their energy via aerobic metabolism. The primary substrates or substances that are needed for aerobic metabolism are oxygen and glucose. The body breathes to get oxygen and we eat to break down the food into sugar. Even if a person just eats protein, ultimately the body finds a way to break down the protein into individual amino acids and eventually into glucose. Without glucose, the cells and the body cannot live.
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The Cortisone Debate Goes On
A December 2020 study published in the medical journal Rheumatology gives this overview assessment of the debate surrounding the use of cortisone for a bone on bone knee. Here are the summary learning points:
- Existing data indicate that intra-articular corticosteroids in knee osteoarthritis provide short-term pain relief and functional improvement which may last from one to several weeks.
- At present, synovitis is the most important predictor of treatment response, and also a target for anti-inflammatory treatment for intra-articular corticosteroids.
- Our explanatory note: If you have a lot of knee swelling cortisone maybe be of benefit. Please see our article treating chronic knee swelling.
Returning to the research study:
- subgroup of patients with the inflammatory phenotype with clinical features of pain, stiffness, joint swelling, and effusion are expected to be more responsive than other phenotypes who do not display clinical manifestations of inflammation.
- Our explanatory note: If you do not have chronic knee swelling, cortisone may not be an answer for you.
How Steroid Injections Are Given
Steroid injections are usually given by a specialist doctor in hospital.
They can be given in several different ways, including:
The injections normally take a few days to start working, although some work in a few hours. The effect usually wears off after a few months.
If you’re having an injection to relieve pain, it may also contain local anaesthetic. This provides immediate pain relief that lasts a few hours.
You should be able to go home soon after the injection. You may need to rest the treated body part for a few days.
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How Long Does A Cortisone Shot Last
Learn about the factors affecting how long cortisone shot pain relief lasts.
When inflammation caused by arthritis makes joints painful and daily activities difficult, a cortisone shot can be an important tool in your treatment plan. This treatment delivers medication directly to the inflamed joint to suppress localized inflammation. However, it is important to understand that cortisone pain relief is temporary, and that cortisone injections do have limitations.
What Are Corticosteroids
Corticosteroids are a group of steroid hormones naturally produced by the adrenal glands. They include cortisone and cortisol , which have anti-inflammatory properties. Synthetic versions of corticosteroids, including hydrocortisone and methylprednisolone, are often used as medications, including as injectables, to reduce inflammation and pain.
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What Does Cortisone Do
Cortisone, also known as a corticosteroid or a steroid, is a hormone your body naturally produces via the adrenal glands. When delivered as a medication, corticosteroids reduce the activity of your immune system, which relieves inflammation and pain for people with different kinds of arthritis .
Corticosteroids comes in many different forms, which vary by how long they stay in your body, how easily they dissolve, and how quickly they take effect. They can either be delivered locally , or systemically . Systemic corticosteroids are usually taken orally or as injections into a vein or muscle. Local corticosteroids for arthritis can be given as an injection into a joint for other types of health issues, they can also be delivered as skin creams, eye drops, or ear drops.
I Am Having Severe Pain After The Injection
Question posted by sippy2011 on 27 May 2011
Last updated on 19 November 2021 by ChronicPain2
I got Synvisc One injection from Dr. on April 21, 2011. He gave it like an ordinary injection in the knee and said Synvisc One will go in the knee joint on its own. I feel injection is not in the joint, I have severe unbearable pain in the knee, very stiff burning pain, cannot walk and find difficult to drive . At times I feel like throwing up. After I complained to Dr. O\Brian he told me that he cannot do anything for me and go to family Dr.. Family doctor knows little about this injection I dont know what to do. I dont know what kind of side effects this material has and how long this will go on. Please help. Called Genzyme many time. No help.
Hi, I had my first injection out of 3 yesterday. First time getting it. Was very nervous, and told Dr i was. He said to just relax or he cant put the needle in. He had to put it in 2 times, because i wasnt relaxed enough. Finally i was relaxed enough and he put it in. It felt very werid, and i felt the stuff going into my knee cap. It didnt hurt as he put some freezing in. After it was done, i walked out, and it felt werid. about 2 hours later i started to feel alittle bit of pain. I kept walking on my knee to help with the pain. I had to take 2 tylonals for the pain. Laying in bed made my knee feel better. Today it feels better then it did yesterday. 2 more injections to go!! I hope you feel better soon.
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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.
Steroid Injections Significantly Associated With Progression Of Knee Oa
Researchers in both studies used participants from the Osteoarthritis Initiative, a multicenter, longitudinal, observational study of nearly 5,000 participants with KOA, currently in its 14th year of follow-up.
The first study, conducted by the researchers at the University of California in San Francisco, included 210 participants a total of 70 subjects received intraarticular injections- 44 with steroids and 26 with hyaluronic acid. The remaining 140 participants didnt get any injections.
Hyaluronic acid injections are used to reduce knee pain, especially when other treatments havent been effective. Its theorized that the injections could help lubricate joints where cartilage has been eroded by osteoarthritis.
The treatment and control groups were matched by age, sex, body mass index, pain and physical activity scores, and severity of their knee osteoarthritis.
All the participants had an MRI at the time of the injection and two years before and after, and the researchers tracked osteoarthritis progression by comparing the imaging scores from the initial scans and two-year follow-up scans.
Investigators found that steroid knee injections were significantly associated with the overall progression of osteoarthritis in the knee, specifically in the lateral meniscus, lateral cartilage, and medial cartilage.
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Contact Board Certified Surgeons Dr Bigler Or Dr Thomas At The Knee And Shoulder Institute In Las Vegas Nv To Schedule An Appointment:
If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today .
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It Is My Opinion The Increase In The Number Of Hip And Knee Replacements Is A Direct Result Of The Injection Of Corticosteroids Into These Joints This Is An Opinion Now Shared By Many
Corticosteroids, such as cortisone and prednisone, have an adverse effect on bone and soft tissue healing. Corticosteroids inactivate vitamin D, limiting calcium absorption by the gastrointestinal tract and increasing urinary excretion of calcium. Bone also shows a decrease in calcium uptake, ultimately leading to weakness at the fibro-osseous junction. Corticosteroids also inhibit the release of Growth Hormone which further decreases soft tissue and bone repair. Ultimately, corticosteroids lead to a decrease in bone, ligament, and tendon strength.
Corticosteroids inhibit the synthesis of proteins, collagen, and proteoglycans in articular cartilage by inhibiting chondrocyte productionthe cells that comprise the articular cartilage. The net catabolic effect of corticosteroids is inhibition of fibroblast production of collagen, ground substance, and angiogenesis .
Cortisone, even one shot, may cause irreversible damage to the joint and cartilage.
The title of the research above Intra-articular Corticosteroid Injections in the Hip and Knee: Perhaps Not as Safe as We Thought?comes from a study with an October 2019 publication date. This paper, published in the medical journal Radiology lists as its essential messages the following:
A list of side-effects following cortisone injection:
In other words, back to what the researchers titled their paper: Intra-articular Corticosteroid Injections in the Hip and Knee: Perhaps Not as Safe as We Thought?
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Injections For Athletic Injuries
The potent anti-inflammatory effects of the corticosteroids have led to their extensive usage in the management of athletic musculoskeletal injuries: sprains and strains, tendon injury, shoulder injury, rotator cuff disease, tennis elbow, and lateral epicondylitis. Nichols reviewed the risks of locally injected corticosteroids in the treatment of athletic injuries28. He identified twenty-five studies that primarily examined the usage/efficacy of corticosteroid injections in the treatment of various athletic injuries. Of the 983 subjects who received corticosteroid injections in these studies, only minor complications of treatment were reported. He found eighteen selected studies that primarily described complications of corticosteroid injections in the treatment of athletic injuries. Of these, tendon and fascial ruptures were the predominant complications reported. He concluded that the existing medical literature does not provide precise estimates for complication rates following the therapeutic use of injected corticosteroids in the treatment of athletic injuries. Tendon and fascial ruptures are often reported complications of tendon/articular corticosteroid injections, particularly in the case of Achillis tendon.
What Does The Procedure Involve
You can usually receive a knee injection in your doctors office. The procedure only takes a few minutes.
Youll be seated during the procedure, and your doctor will position your knee. They may use ultrasound to help guide the needle to the best location.
Your doctor will:
- clean the skin on your knee and treat it with a local anesthetic
- insert the needle into your joint, which might cause some discomfort
- inject the medication into your joint
Though you may feel some discomfort, the procedure is rarely painful if your doctor has experience administering this type of injection.
In some cases, your healthcare provider may remove a small amount of joint fluid to reduce pressure.
Theyll insert a needle attached to a syringe into the knee joint. Then, theyll draw out the fluid into the syringe and remove the needle.
After removing the fluid, the doctor can use the same puncture site to inject the medication into the joint.
Finally, theyll place a small dressing over the injection site.
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Whats The Procedure For A Cortisone Shot
Heres what you can expect when you get a cortisone injection:
Supplementary treatment options vary depending on your particular issue. Some options may include:
- physical therapy
How And When To Have Hydrocortisone Injections
A specialist doctor will usually give you your injection. This may be at your GP surgery.
If the injection is for pain, it may contain a local anaesthetic. You might also have a local anaesthetic by spray or injection to numb the skin before the hydrocortisone injection.
You can go home after the injection, but you may need to rest the area that was treated for a few days.
You may be able to have a hydrocortisone injection into the same joint up to 4 times in a year. The number of injections you need depends on the area being treated and how strong the dose is.
If you have arthritis, this type of treatment is only used when just a few joints are affected. Usually, no more than 3 joints are injected at a time.
The dose of hydrocortisone depends on the size of the joint. It can vary between 5mg and 50mg of hydrocortisone.
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