From young to old, people are trying to develop and maintain an active lifestyle for as long as possible. Exercise has been shown to be of great value and is an important component of overall wellness. It is prescribed for many health conditions including depression, obesity, heart disease, elevated cholesterol, high blood pressure, arthritis and osteoporosis. As people aim to extend their level of activity and sporting careers, many orthopaedic and musculoskeletal injuries, can impede these goals. One of my goals as a Primary Care Sports Medicine Physician is to help patients manage their injuries so that they can continue to be active and participate in the activities that they enjoy for as long as possible. This will not only help keep them happy, but it will also allow them to continue to experience the proven benefits of exercise.
Treatment of injuries requires a multifaceted approach addressing a patient’s biomechanics, posture, activity modifications, flexibility, and supporting muscle strength. Focused physical therapy and rehabilitation can be quite helpful, and in some cases, might be all that is needed. In cases that do not respond to these methods, a therapeutic injection may be offered by a physician. The most common type of injection involves a combination of a local anesthetic medication called lidocaine, with an anti-inflammatory medication called a corticosteroid. This is what is known as the traditional “cortisone injection.” The goal of these injections is to allow patients to continue with rehabilitation and offer relief from pain not responsive to other conservative measures.
For patients suffering specifically from knee osteoarthritis, a different type of injection, termed viscosupplementation, might also be offered. This is a preparation of hyaluronic acid, which is a naturally-occurring substance found in normal, healthy knee joint fluid. People with arthritis typically have lower-than-normal concentrations of hyaluronic acid in their joints. These injections act as a lubricant to enable the bones to move smoothly over each other, as well as aiding as a shock absorber. Long term, the injections can lead to decreased pain, inflammation, and may also stimulate the body to produce more of its own hyaluronic acid.
Traditionally, injections have been given based on anatomic landmarks; meaning that a physician feels for certain bones, muscles, or tendons, and then injects blindly into the desired area. The concern with this method of injection is that there is no way of definitively knowing where the tip of that needle is, and where that injection is going. Many of the structures that we are aiming for are only millimeters in size. More recently, ultrasound-guided injections have been gaining in popularity. In this method, ultrasound imaging using high frequency sound waves helps to visualize the body structure of the injection. The needle can be seen on the ultrasound screen and the precise location of the injection is assured.
Many recent studies have been performed, comparing the efficacy of blind versus ultrasound-guided injections. These studies have shown that ultrasound-guided injections are associated with significantly less procedural injection pain and provide more pain relief. The pain relief lasts for a longer duration, and ultrasound-guided injections have been measured to be more effective than blind injections. The improved performance of ultrasound-guided injections leads to a decrease in health care costs per patient, while improving patient care. If you are experiencing joint pain that could be helped by an injection, ask your doctor for a referral to a provider with experience in musculoskeletal ultrasound-guided injections.