Comparing Botox To Other Treatments
A June 2019 study in the journal Clinical Rehabilitation compared the effectiveness of intra-articular injection of Botulinum toxin type A , triamcinolone hexacetonide , and saline in primary knee osteoarthritis. The study found the cortisone injections had higher effectiveness than Botox or the saline in the short-term assessment for pain in movement.
Side Effects Of Injection Therapies
Side effects include a very low risk of infection and pain at the injection site. You also must stop taking oral anti-inflammatory medications for a short amount of time if you get a PRP injection, Dr. Genin says.
Often, many of these injections are effective in reducing or stopping your joint pain, but its important to remember that they may not keep the pain from returning, Dr. King notes. In fact, theyre most effective when used with other therapies. And we consider surgical options only if other treatment options have failed.
Medications Used In The Knee Injection
The following medications are often used alone or in conjunction with each other when performing a knee injection:
- A local anesthetic agent
- An injectable corticosteroid
- A skin preparatory agent to disinfect the skin prior to injection
- A skin anesthetic agent to reduce the pain of the injection
The medications i used were as follows and for the following reasons:
1) Marcaine 0.25% solution in a multidose vial:
I liked this long acting local anesthetic agent because it gave very rapid pain relief and persisted until the other medicines in the mix could begin to work. If you look at the literature about this anesthetic agent it is not officially approved for joint injections. This is because it can cause cartilage damage when used as a continuous infusion into the joint when using the O.5% concentration.
In my mix we used the 0.25% solution and never more than 1cc . This very low concentration of Marcaine never caused any reactions in any patients in over 26 years of practice.
2) Depo-Medrol 40 mg per cc multidose vial:
This is a moderate acting corticosteroid that is a suspension which prolongs the duration of action of the medicine. Although there are many side effects that can occur with the systemic administration of corticosteroids, when given into a joint the systemic absorption is much less and subsequently the side effects are less also.
3) Sarapin is a natural anti-inflammatory made from the Pitcher plant.
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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 Happens During The Procedure
First, your doctor will draw a small amount of blood from your arm.
Then, theyll put the blood sample into a centrifuge to separate the components and obtain a concentrated suspension of platelets in plasma. At this point, variations in procedure may lead to different concentrations of the various components.
Next, the doctor will numb your knee and inject the PRP into the joint space in the knee. They may use ultrasound to guide the injection.
After resting a while, you will be able to go home. You should arrange for someone to drive you home, as there may be pain and stiffness after the injection.
After the procedure, your doctor may advise you to:
- ice your knee for 20 minutes every two to three hours for the first three days
- take Tylenol to help manage discomfort
- avoid NSAIDs, like ibuprofen, since they may block the effect of PRP
- get plenty of rest and avoid activities that put weight on your knee
You may need to use crutches or a walking frame for a few days to keep the weight off of your knee.
Follow your physicians advice about follow-up appointments.
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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.
How Is Knee Injection Performed
Knee injection is a relatively quick procedure and may be performed under local anesthesia to avoid pain. A needle of appropriate size and length connected to a syringe is introduced into the joint and the medication is injected. Radiological guidance may sometimes be used to aid injection.
After the procedure, the patient would need to rest for a few minutes, and then they can resume normal activities. Patients may experience pain, swelling, and bruising, which resolve in a few days. Ice packs and pain killers can help reduce pain and bruising.
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The Best Ways To Reduce Discomfortand What You Can Probably Skip
Knee osteoarthritisa progressive loss of cartilage at the ends of knee jointscan cause pain, stiffness, and swelling. And about half the estimated 15 million Americans with knee OA have a severe form of the progressive condition.
In their search for relief, many people may be turning to the wrong treatments, according to a 2017 study published in The Journal of Arthroplasty.
We suspect both patients and providers are trying to exhaust conservative measures in an attempt to avoid surgery, says study leader Nicholas Bedard, M.D., orthopedic surgery resident at the University of Iowa Hospitals and Clinics in Iowa City.
His team looked at the records of more than 86,000 people whod had knee replacements and found that in the year before the surgery, theyd spent nearly $44 millionan average of $506 eachon questionable therapies such as opioid pain medications.
But if opioid drugs are a poor choicetheyre potentially addictive, and a published in JAMA found them of no use for moderate to severe knee OA painwhat are the most effective ways to handle your discomfort? Here, the experts weigh in.
When Other Treatments Arent Working See If These Shots To Relieve The Painful Symptoms Of Knee Osteoarthritis May Be Right For You
Youve tried all the conservative therapies for your knee osteoarthritis, and nothing is working. You really, really dont want to go down the knee replacement surgery road yet. Whats left to try? You might want to consider hyaluronic acid injections for your knee osteoarthritis . Be warned, though: Their effectiveness is up for debate, with medical research not quite backing up how well they work.
Yet, individual patients have reported relief from their arthritis pain with the shots but not everyone. Even a CreakyJoints Facebook post soliciting feedback on patients experiences received responses ranging from they worked like a dream and amazing to they did nothing to relieve my OA knee pain and even they made my knee worse.
Read on to find out more and decide if hyaluronic acid injections are worth a shot for you.
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Doctors With Superior Medical Knowledge And Compassion
One of the many benefits of choosing NorthEast Spine & Sports Medicine is that we only use the most innovative and modern treatment options and procedures. Furthermore, every service and treatment option we offer is available at each of our eleven offices. Therefore, you should expect to receive the treatment you need whether you visit our office in Jackson, NJ, Point Pleasant, NJ, Barnegat, NJ, Manchester, NJ, Aberdeen, NJ, Rahway, NJ, or Tinton Falls, NJ. Furthermore, when patients come to one of our offices, they are always greeted with smiles and treated with kindness.
Every member of a team is respectful and empathetic, and will go to great lengths to ensure your pain management needs are addressed. Another reason to choose our medical practice is because our team makes it one of their highest priorities to stay at the forefront of medical research so that theyre offering the best care possible. Lastly, our physicians and staff also make certain that patients have the knowledge they need to help them live pain-free lives.
Reduce Inflammation With Steroids
Corticosteroid injections are useful for treating flare-ups of OA pain and swelling with fluid buildup in the knee, Richmond says.
These injections help relieve symptoms by reducing inflammation in the joint. But theyâre not a perfect solution in every case. If you’re considering this treatment, keep this in mind:
They work quickly. These injections offer âvery rapidâ relief, usually within 24 to 48 hours, Richmond says.
The benefit is short-term. On average, the pain relief lasts from 6 to12 weeks, Richmond says. Often, thatâs long enough to get you through a flare-up of osteoarthritis until your symptoms subside.
You shouldnât use them frequently. A corticosteroid shot often works best the first time, Altman says. After that, they tend to give less relief.
In most cases, Richmond tells his patients they can use these shots two to three times a year. Using them too often may damage cells in the knee that make cartilage.
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The Physiology Of The Knee
The knee is a swinging-hinge mechanism. The actual major motion is in the form of an arc. It is really an eccentric arc that places stress on different structures within the knee at different phases of its motion. The study of this movement is called kinesiology.
In the standing position the knee ligaments and tendons are at their least stress. The major stress standing is compressive and is applied to the cartilage located on the end of the tibia and femur .
As the knee begins to bend, the patellar tendon tension begins to rise first. As motion continues tension in all ligaments and tendons builds to reach maximum stress at the fully bent position . A full squat places the greatest tension on the structures of the knee.
Ironically, the knee is the most vulnerable to external forces in its least stressed position, the partially bent knee . Presumably, this position allows external forces to separate the knee compartments easiest due to ligament and tendon laxity.
Ligament shearing remains a major mechanism of injury in sports. More recent orthopedic surgical techniques utilizing cadaver ligament and tendon transplants , as well as tendon transplants from one part of the same persons body to another , have improved recovery from cruciate ligament tears.
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 remains.
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.
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Joint Injections For Arthritis Pain
Learn about injection options to manage arthritis pain and symptoms.
A complete plan for managing your arthritis will include an array of therapies and treatments. They may include self-care measures like diet, exercise and heat/cold therapies physical therapy oral medicines topical medicines and even some injectable treatments. Here well review some of the medicines and other compounds that may be injected directly into your arthritis-affected joints.
Corticosteroids
What it is: A combination of a corticosteroid and a numbing agent is injected directly into the joint affected by arthritis. These shots are given in the doctor’s office and usually are covered by medical insurance.
Benefits and Risks: Injections provide safe and effective reduction of pain and inflammation. Relief typically lasts about a month. An extended release formula called Zilretta was approved in 2017. It provides 3 months of symptom relief.
Somepeople will have a temporary flare of pain in the injected joint, which should resolve in 48 hours. Repeated cortisone shots can cause the cartilage to deteriorate and weaken tendons and ligaments around the joint.
Who its Best for: Steroid injections are good for people with a very painful or inflamed joint who need fast, temporary relief.
Joints treated: Ankle, elbow, hip, knee, shoulder, and small joints of the hands, feet, spine and wrists.
Hyaluronic Acid
The most common side effects are pain, swelling, and stiffness in and around the joint.
How Effective Are Hyaluronic Acid Injections In Remedying Chronic Knee Pain
Maybe your knee pain is worse when you wake up in the morning and are just starting to move around for the day. Or perhaps, by the end of the day, your knees are screaming for relief. Whatever your experience with knee pain, we know you want effective relief now.
Our anesthesiologist and pain management expert Syed Nasir, MD, here at Skilled Pain Care Clinic, PA, in Houston and Katy, Texas, offers an expert diagnosis of the many conditions and injuries that can cause knee pain. He creates personalized treatment plans to reduce your pain quickly and heal the underlying condition for long-term relief.
One of the many treatments available are hyaluronic acid injections, but are they useful for all types of knee pain?
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Who Can Benefit From Prp
PRP is an experimental therapy, and experts do not currently recommend its use. If you are considering PRP injections, start by asking your doctor for their advice.
Since PRP injections are experimental, there is limited evidence about how safe and effective they are. In addition, your insurance policy may not cover them.
Work closely with your doctor before starting any experimental treatments, and ensure that any provider is fully qualified to offer this treatment.
Therapeutic Injections For Osteoarthritis Of The Knee
If physical therapy and pain medication taken by mouth dont relieve the aching pain caused by osteoarthritis of the knee, doctors may recommend an injection of medicine directly into the arthritic joint. Therapeutic injections may give you the relief you need to begin physical therapy or other exercise to strengthen the muscles supporting the knee.
An injection of corticosteroids or hyaluronic acid may reduce inflammation and ease pain. Other more experimental injectionssuch as platelet-rich plasma or stem cellsmay relieve pain and encourage healing in damaged soft tissues. Your doctor can discuss whether you are a candidate for these experimental injections, which are not approved by the U.S. Food and Drug Administration to treat knee osteoarthritis. Some people find that therapeutic injections provide long-term pain relief and help them remain active, but they may not be appropriate for everyone.
Our doctors can use live X-ray or ultrasound imaging to guide the injection precisely into the knee joint, ensuring that the medication has the maximum effect.
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Platelet Rich Plasma Injections
Platelet Rich Plasma is relatively new to orthopedics but has been used during surgery for cell regeneration for the last 20+ years. PRP is derived from your immune systems platelets which are found in blood. The platelets are then concentrated and can be injected into the troubled joint area.
PRP injection therapy is said to stimulate healing by producing more collagen. The formation of collagen occurs naturally in skin, bones and tissue. Building collagen in a troubled joint means adding support and even correcting underlying issues caused by arthritis, dysplasia and diseased bone and cartilage. This can reduce pain and improve function.
Timeline: Lasts 3-4 months and can be repeated 1-2 times a year. Cost: Not covered by insurance. $500+.
Pros
- PRP injections are safe with few risks or side effects since the injection substance is naturally occurring in your body.
- Some studies show that PRP is most effective in combating joint paineven more so than cortisone or viscosupplementation. AAOS published a study in April 2017 where a controlled patient group that had PRP therapy showed a 90 percent decrease in pain from baseline. Patients in the steroid group showed an 8 percent increase in pain from baseline.
Cons
PRP injections are offered by private clinics across the USA. Since they are not regulated, prices vary. Single treatments range from $500 to $1250+ depending on location and clinic.
Lose Weight To Lessen Stress On Your Knees
Number one on Valaiks list of ways to reduce knee pain and delay knee replacement: reaching and maintaining a healthy weight.
Extra weight puts pressure on the knees and increases stress on the joint, increasing pain and making it hard to exercise, Valaik explains. Research compiled by the Johns Hopkins Arthritis Center confirms that carrying extra pounds raises your risk of developing knee arthritis and speeds up the destruction of cartilage that cushions the joint.
I know its not easy, he says, but losing weight really helps, whether youre dealing with arthritis in one or both knees. If you are overweight or obese, consulting with a nutritionist or a bariatric specialist may be the right place to start.
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