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What Do They Inject In Your Knee For Pain

Why You Should Get A Gel Knee Injection

Do gel injections eliminate knee pain?

1) Gel knee shots are for patients who find other treatments ineffective

This course of action is recommended for patients who dont experience relief from physical therapy or other injections. Additionally, patients with diabetes often choose gel shots since corticosteroid injections another common treatment raise blood sugar levels. If overused, cortisone can deteriorate cartilage in knees, while gel shots do not.

2) Gel knee shots last longer than other treatment options

A typical regimen of gel shots consists of three to five weekly injections. Patients can then enjoy pain relief from osteoarthritis for up to six months on average.

3) Gel knee shots are approved by the FDA

The FDA approved the first gel injections in the late 90s. There are now more than six different brands available. All of them have been deemed equally effective by independent clinical trials.

Types Of Gel Injections

Viscosupplementation, commonly referred to as gel injection, is an injection into the knee joint with a gel-like substance called hyaluronate, or hyaluronic acid. Hyaluronic acid is one of the naturally occurring lubricants in a healthy knee. According to the Cleveland Clinic, pharmaceutical companies in the United States have developed three main hyaluronic acid-based gels, known by the brand names Hyalgan, Synvisc and Supartz. Some of the injection gels are made from biological sources, while others are created synthetically. The technique of viscosupplementation was approved in 1997 by the U.S. Food and Drug Administration for use in the knee, according to the American Academy of Orthopaedic Surgeons.

What Is Hyaluronic Acid And What Does It Do

Hyaluronic acid, also known as hyaluronan, is a gel-like substance naturally present in the synovial fluid that lubricates your joints. Because arthritis patients lose hyaluronic acid as their joint wears away, the theory goes that replacing it with a process called viscosupplementation would make using the joint less painful. The injections are FDA-approved for knee osteoarthritis.

Its mechanism of action is not fully known, but is thought to at least temporarily increase the viscosity, or thickness, of the fluid that surrounds the joint it is injected into, says;Donald Miller, PharmD, a professor;at the School of Pharmacy at North Dakota State University. This may reduce pain and make joint movement easier.

You can think of it like WD-40 for your joints.

Read Also: Does Gout Occur In The Knee

Likely Factors For Success

The people who do seem to respond best to hyaluronate knee injections are of normal weight and have only the beginning stages of osteoarthritis. The injections are most effective in people with just mild to moderate arthritis. If youre highly overweight or obese and have advanced osteoarthritis, the injections are less effective.

Hyaluronate injections also seem more effective on people younger than 65. If youve never had treatment with hyaluronate or steroid shots, youre also a better candidate.

What Other Alternatives Are There


Other Pharmacological Treatments: There are other types of injections for the knee joint such as hyaluronic acid and Platelet Rich Plasma that could provide a similar benefit. Various prescription and over the counter oral anti-inflammatorydrugs can also provide quick relief from pain. However, many of them come with a high risk of adverse side-effects.

Non-Drug Treatments: If you are worried about the risk of negative side effects associated with injections and oral pain killers conservative treatmentmay be for you. The focus here is to avoid/delay surgery, get you off painkilling drugs and improve the health of your knee joint.

Offloader Knee Braces: If you have knee osteoarthritis and want to preserve what cartilage you have left, offloader knee braces could be the right fit for you. These knee braces actively reduce the pressure between the bones in your knee joint significantly reducing pain.

Read Also: How Much Is Total Knee Replacement Surgery

You Are Sitting In The Orthopedists Office: The Discussion Turns To Cortisone

If you have been to your orthopedist recently and are planning treatment options or surgical options you may have been given a paper handout or webpage to visit or verbal advice on what to expect if you are getting a cortisone injection into your knee.

You may have been told:

The cortisone injection is to help you now, it is not a permanent solution.

  • It is to hold you over until a more effective plan can be introduced.

Physical therapy may be an option instead of the cortisone injection

  • You may then be suggested to physical therapy or continued physical therapy. As we will see below, research suggests that physical therapy would work better than cortisone. But while that may be true for some, it is likely that you are at the cortisone or repeated cortisone injection stage because physical therapy has not worked for you. So you have been to physical therapy and it has not helped you. That is why you are getting the cortisone shot. In fact, you may have tried, yoga, stretching, exercise, and massage for knee pain, and these treatments just didnt help.

You need to lose weight so the cortisone will work better

  • It should be noted that surgeons writing in The Journal of the American Academy of Orthopaedic Surgeons published findings in which they suggested:
  • What Happens During A Hyaluronic Acid Injection

    Here at Skilled Pain Clinic, Dr. Nasir begins with a thorough consultation and exam to identify the cause of your knee pain. He needs to understand the cause of your pain in order to prescribe the most effective treatment. If you have osteoarthritis, and Dr. Nasir thinks hyaluronic acid injections will relieve your pain, he can provide hyaluronic acid injections during a brief visit.;

    When you have the injection, Dr. Nasir cleans the skin on your knee and may inject a local anesthetic. If you have severe swelling, he may perform a joint aspiration to extract some of the excess fluid. Then, using an X-ray to guide the needle, he injects the hyaluronic acid into your knee.;

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    Hyaluronic Acid Injections Or Viscosupplementation For Knee Osteoarthritis

    Much like cortisone, it is very likely that this knee injection treatment has been explained to you already by your orthopedist. It is a conservative care plan to help you try to manage along until you can get a knee surgery scheduled or you are trying to do everything you can to avoid the knee surgery.

    Also like cortisone, you may have already had viscosupplementation and the effects and benefits have now worn off and you need to treat your knee differently. For some people, they may not even be reading this sentence because they have moved down the article to other treatments because this one is no longer an option for them.

    What is Hyaluronic acid injections or Viscosupplementation?

    The explanation that you may have been given is that hyaluronic acid injections will provide a gel-like cushion in your knee, getting between the shin and thigh bones to alleviate your bone-on-bone situation. The injections increase the volume of the protective synovial fluid in the knee.

    • The treatment is therefore referred to as Viscosupplementation because you are supplementing the viscosity or the thick, sticky, gel-like properties of the synovial fluid. Hyaluronic acid is naturally occurring in the synovial fluid of the knee.

    Different Types Of Knee Injections

    The Top 5 Types of Knee Injections Explained from an AZ pain center (602) 507-6550

    Here are a few of the most common types:

    • Corticosteroid; When injected in the knee or other joints, Corticosteroid injections reduce pain and inflammation. These effects generally last for 2-3 months. A patient can only receive a limited number of these injections per year.
    • Platelet-Rich Plasma ;PRP shots use a patients plasma to promote healing of the soft tissue and reduce inflammation. Doctors frequently use these injections to treat osteoarthritis, as they are low risk and have limited side effects.
    • Hyaluronic Acid Injections or Viscosupplementation; These are the technical terms for knee gel injections. As outlined above, a Hyaluronic Acid injection reduces pain and inflammation by mimicking the effects of natural joint fluid. They are best for patients with diabetes, as they do not raise blood sugar levels like Corticosteroid shots. Gel-One is one of the most commonly prescribed forms of HA treatment.

    Read Also: How To Get Rid Of Growing Pains In Knees

    Caring Medical Research Prolotherapy For Knee Pain

    In published research in the Journal of Prolotherapy, Ross Hauser MD investigated the outcomes of patients receiving Prolotherapy treatment for unresolved, difficult to treat knee pain at a charity clinic in Illinois.

    • 80 patients, representing a total of 119 knees, were treated quarterly with Prolotherapy.
    • The results of this study showed that patients had a statistically significant decline in their level of pain, stiffness, crunching sensation, and improvement in their range of motion with Prolotherapy.
    • More than 82% showed improvements in walking ability, medication usage, athletic ability, anxiety, depression, and overall disability with Prolotherapy. Ninety-six percent of patients felt Prolotherapy improved their life overall.

    Knee Pain On The Inside Five Common Injuries

    Meniscus Irritation or Injury

    The medial meniscus helps absorb weight as you move, particularly during high impact activities like running and jumping. It is often injured while playing sports. Unexpected collisions, stopping and starting at high speeds and twisting movements are the events that typically result in meniscal injury. Afterward, you may notice pain and swelling throughout the knee especially on the inside of the joint. You will also experience a loss in range of motion, and may feel like your knee is unstable while walking. If you have suffered a traumatic injury to your meniscus you should seek medical attention immediately. Depending on the nature of the tear, surgery may be warranted.

    While traumatic meniscus injuries are common, it is also possible to irritate the meniscus through repetitive movements. Frequent squatting and bending while working, can over time, cause small fissures to develop in the meniscus resulting in nagging pain and instability. In these situations, an offloader knee brace can be a great treatment option. Because the brace actively reduces pressure on the joint, it will help keep you on your feet and working while letting your meniscus heal.

    Pes Anserine Bursitis

    Synovial Plica Syndrome

    Medial Collateral Ligament Sprain/Strain

  • Grade I: The MCL has been overstretched, while there is no major damage, its function will be compromised until it has healed.
  • Medial Knee Osteoarthritis

    Whats Next?


    Recommended Reading: Can You Fix Arthritis In The Knee

    How Long Does Rooster Comb Injections Last

    Depending on the brand, patients usually require one injection a week for a period of three to five weeks. The good news is that the rooster comb knee injections are known to provide the relief of a symptom for about three to six months, despite the fact that they often require longer than 24 hours for the initial effect, as compared with the classic corticosteroid injections.

    Then Why Is Your Doctor Still Recommending This Treatment

    Common joint pain treatment may be more harmful than thought

    Lets let Dr. Leopold continue:

    One reason might be that surgeons have relatively few effective nonsurgical alternatives that help patients with their joint pain, andbeing members of a helping professionwe find this frustrating. However, our lack of effective nonsurgical treatments cannot justify the use of an ineffective one, and it must not be used to justify surgery unless surgery is indicated. Some patients will have pain that persists despite well-tested nonsurgical treatments, but not enough to warrant major joint surgery; others may not fit the biopsychosocial profile that supports a decision to perform elective arthroplasty. The answer to this is not to use a treatment like viscosupplementation that studies suggest is ineffective, nor to take a chance on surgery when it seems ill-considered to do so, but rather to explain to patients that there are some problems for which we have no effective treatments, and to help those patients adjust and adapt.

    Read Also: What Is Good For Osteoarthritis Pain In The Knee

    Which Conditions Can Be Treated Using Genicular Nerve Block

    Conditions commonly treated with genicular nerve blocks:

    • Knee OsteoarthritisThis type of arthritis is due to wear and tear on the knee joint
    • Chronic knee painChronic knee pain can be caused by tendinitis, injury, osteoarthritis, gout, or other conditions
    • Degenerative Joint Disease;;
    • Patients with pain after total or partial knee surgery
    • Patients with chronic knee pain who are not surgical candidates

    A Third Option: Platelet

    Some doctors are using this type of knee injection to treat knee OA symptoms. Doctors take your blood and collect the platelets, the part of blood that forms clots. They increase the number of platelets and inject them into your knee. Natural chemicals in platelets help heal injuries and lower inflammation.

    Experts are still researching how well it works for osteoarthritis. It’s very expensive and still in early stages of research, Albayda says, so it’s not a mainstream form of OA treatment.

    Also Check: How To Prevent Knee Pain In Old Age

    The Knee Injection Process

    1) Initial examination

    Accurate diagnosis is the key to treating any disease. After a thorough history and examination, x-rays are used to confirm the diagnosis. Osteoarthritis presents as narrowing of the joint space or space between where two bones come together. There are different medicines and products used to treat osteoarthritis, and your doctor would help guide you to the treatment best suited for your condition.

    2) Preparing the patient

    Sterility with any injection is important, so the first step includes thoroughly cleaning the skin where the needle will be inserted into the knee. Next, a cold spray freezes the skin just prior to the physician inserting the needle, which numbs the skin to reduce discomfort. Typically, a local anesthetic is injected into the joint to reduce post-procedure discomfort.

    3) Locating the joint space

    This is the most important part of the process because a doctor cant inject your knee just anywhere. The injection must go into the part of your knee with the arthritis, or youll never feel relief.

    At Arthritis Relief Centers, we use Hologic Digital Imaging a low-dose x-ray to precisely direct the needle exactly where it needs to go. Without this technology, theres a 30+% chance a doctor will miss the part of your knee that most needs pain relief from arthritis.

    4) The Injection

    5) Post-Injection Instructions

    Gel Injections And Stem Cell Therapy

    Knee joint steroid injection

    Stem cell therapyis an extremely exciting area of research that may one day change how knee osteoarthritis is treated. Currently, patient outcomes from stem cell therapy are inconsistent with respect to re-growth of healthy knee cartilage. Hyaluronic acid may one day be part of the solution. The combination of hyaluronic acid and stem cell therapies may be more effective than either treatment alone. Some studies have shown that combined therapies have increased the chance of rebuilding cartilage8. Hyaluronic acid appears to enhance the capacity of stem cells to form cartilage, allowing the treatment to become more effective. Clinical trials are currently underway for this combination therapy9.

    Read Also: Which Knee Brace To Buy

    Another Comparison Of Ozone Prp And Hyaluronic Acid

    A February 2021 study compared the short and long-term efficacy of the intraarticular injections of hyaluronic acid, platelet-rich plasma , plasma rich in growth factors , and ozone in patients with knee osteoarthritis.

    • 238 patients with mild to moderate knee osteoarthritis were randomized into 4 groups:
    • hyaluronic acid ,
    • PRP ,
    • PRGF , and
    • Ozone .

    Results: In 2 months of follow-up, significant improvement of pain, stiffness, and function were seen in all groups compared to the baseline, but the ozone group had the best results. In 6 month follow up hyaluronic acid, PRP, and PRGF groups demonstrated better therapeutic effects in all scores in comparison with ozone. At the end of the 12th month, only PRGF and PRP groups had better results versus hyaluronic acid and ozone groups in all scores. Despite the fact that ozone showed better early results, its effects begin to wear off earlier than other products and ultimately disappear in 12 months.

    Why Would An Arthritis Patient Get Hyaluronic Acid Injections Vs Other Treatments

    Typically, you would try other conservative treatments first, like weight loss, exercise, NSAID medications, and;steroid injections. If those dont help, hyaluronic injections may be an option.

    Some patients might have other conditions for which for first-line treatments would be contraindicated. Some doctors might use hyaluronic acid injections along with steroid injections as well. I had the injection every week for three weeks along with cortisone injections, Sharon Ruoto told us on Facebook. I did this every six months for years.

    Although hyaluronic acid is also available as a pill, the shots are usually preferred. Advantages are targeted relief to the joint with no systemic side effects from pills, and the convenience of not taking pills by mouth, Dr. Miller says. Brand names of the hyaluronic acid shot include Euflexxa, Supartz, and Synvisc-One.

    Read Also: What To Do For Sore Knees

    Amniotic Cord Blood And Placenta Tissue

    There is a great amount of misinformation surrounding amniotic stem cell therapy, and umbilical cord blood stem cell therapy.We have never offered these treatments.

    The primary reason we do not offer these products is that we did not find them to be more effective or economically viable to the patient than the utilization of the patients own stem cells and because we find simple dextrose Prolotherapy and Platelet Rich Plasma to be effective treatments which, in our observations, yield similar if not better results.

    Amniotic stem cells marketed in many chiropractic offices are, in reality, micronized amniotic fluid. The micronization process takes amniotic fluid, freeze-dries it, and then processes it. The process kills the stem cells. NO live stem cells are present. However, growth factor remnants remain.

    Many people attend webinars and seminars on the benefits of amniotic/placenta, umbilical cord stem cell therapy. These seminars are often conducted by a chiropractor whose presentation includes a segment on how the attendees of the seminar have joint pain because their own stem cells are too few, too weak, too feeble, and too old to repair the damage.

    The great irony of this argument is if you have been told that your own stem cells are too few, too weak, too feeble, and too old, how does the amniotic tissue then work if it has no new stem cells in it?


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