Everything you wanted to know about intra-articular injections: 10 expert questions and answers

Arthritis, arthrosis are diseases with an inflammatory course, in which the synovial membrane of the joint is affected and effusion accumulates in the cavity. The knee joint is a complex problem, when pain during degenerative-dystrophic processes is exhausting and sharply worsens the quality of life. Injections are the most accessible method of therapy:

quickly eliminate pain at the bottom of the knee, side and inside;
relieve swelling;
normalize the condition of cartilage tissue.

The most effective are intra-articular injections (pain injections), which instantly eliminate side effects at the site of inflammation and do not affect other internal organs.

No. 1. Why are intra-articular injections better than intramuscular ones? Or do they give the same result?

Intra-articular injections are more effective than intramuscular injections because the medicine is delivered directly into the affected joint. A variety of medications are sent into the cavity, which relieve pain and inflammation, restore cartilage tissue, and become synovial fluid prostheses. The main thing is that they act in a targeted manner. Intramuscular injections are less effective, since the active substance is distributed throughout the body through the bloodstream and enters the joint in a much lower concentration.

Intra-articular injections hit the target exactly – they act on the affected joint

Features of application

For intra-articular injections to be effective, they should only be administered by an experienced orthopedic specialist. In this case, the treatment procedure will be painless and will not harm the patient. To carry out the manipulation, a syringe with an elongated needle is used, which is directed directly into the area of the joint space. To minimize errors during intra-articular injection, regular ultrasound monitoring is used.

In some cases, before introducing medications into the joint, fluid is pumped out of it. This is necessary to collect material for research or to eliminate possible complications. When the joint is dry, the doctor injects the medicine into the appropriate cavity.

Some patients mistakenly believe that the intra-articular injection procedure is accompanied by pain. However, this is not true. Since long and thin needles are used for manipulation, the patient’s sensations are no different from standard intramuscular injections. To distribute the medication evenly inside the joint, it is necessary to make slight movements. In some cases, a tight bandage is recommended.

When treating a joint using intra-articular injections, it is not necessary to adhere to strict rehabilitation measures. However, it is advisable to eliminate the load on the limb. This is necessary to prevent complications and increase the effectiveness of therapy. Therefore, it is important to avoid lifting loads and not to drink alcohol.

#2: Are there studies that support the effectiveness of this method?

Despite the fact that the method has not been used for the first year, its research is regularly carried out all over the world, namely testing old and new drugs. Particular attention is paid to drugs based on hyaluronic acid and its synthetic substitutes, since the method of restoring synovial fluid in the joint is considered one of the most effective in the treatment of osteoarthritis.

From year to year, the drugs confirm their high effectiveness compared to tablets that relieve pain and inflammation. Synthetic analogues, for example Noltrex, which does not cause allergies or adverse reactions, are considered safer and more effective.

Injectable drugs

In the process of intra-articular administration of medications, various groups of drugs are used. Their selection is made by an experienced specialist based on the characteristics of the disease and the patient’s condition. In this case, corticosteroids, chondroprotectors, hyaluronic acid, etc. are most often used.

Corticosteroid group

These hormonal drugs, which are based on corticosteroids, are prescribed to relieve severe inflammatory changes. Corticosteroids in tablets have a similar effect, but intra-articular injections provide faster penetration into the affected area and high therapeutic efficiency. At the same time, side effects on the body are minimal or absent due to the local nature of the medications used.

In the treatment process, it is recommended to give preference to corticosteroid drugs in the form of intra-articular injections, for example, Flosteron, Diprospan, Hydrocortisone, Kenalog, Celeston. In some cases, they are used in combination with anesthetics (Lidocaine) and vitamin preparations.

Intra-articular injections are effective in relieving inflammation, swelling and pain. Thanks to the use of such drugs, joint mobility increases. However, these injections cannot cure the disease itself and ensure the restoration of cartilage tissue.

The achieved effect from their use is about 2-3 months. There is another drawback of corticosteroids - they cannot be used for arthritis of infectious origin. For such a disease, joint lavage and antibiotic administration will be required.

Chondroprotectors

These drugs are prescribed for active degenerative processes in the joint area, which accompany, for example, arthrosis. As a result of such changes, cartilage tissue is destroyed. Chondroprotectors are able to slow down such negative changes and have a positive effect on joint restoration.

The effect of drugs in this group is based on their ability to normalize metabolic processes and stimulate the production of natural collagen. It is this component that is necessary for the construction of cartilage tissue and healing of damage. At the same time, you should not expect an immediate effect. These drugs belong to the group of long-term therapy. The intra-articular injection method helps speed up the action.

Alflutop is often used in the therapeutic process - a simple but effective means for intra-articular injections from the group of chondroprotectors. With an uncomplicated course of the disease, 4-5 injections are usually enough to improve the patient’s condition. Severe diseases require a longer course of treatment.

It is important to remember that the effectiveness of chondroprotectors is manifested not only in the initial stages of the development of degenerative processes. They can also be used in a neglected state. However, in the latter case, their action will mainly be aimed not at stimulating tissue regeneration, but at preventing further destruction of cartilaginous structures.

Hyaluronic acid

Preparations containing this component demonstrate their effectiveness in the treatment of joint problems. Hyaluronic acid is part of the intra-articular fluid, which plays the role of lubricant in the joint structure. It provides protection against injury during movements.

Gas injections

Carboxytherapy is a modern method used in the complex treatment of diseases of the joints and spine. It allows you to effectively relieve pain. Carbon dioxide is used for injections. It is administered using auxiliary equipment. Due to a sharp increase in the concentration of this gas in the joint structure or muscles after the injection procedure, the body begins to experience an artificially induced lack of oxygen. Therefore, the deficiency needs to be replenished, and blood begins to flow more actively to the affected area.

At the site of intra-articular injection, blood circulation increases and metabolic processes are activated. Carbon dioxide does not harm the body because it is quickly and effectively removed within a short period of time. The positive effect of treatment lasts for a long time. When using injections with gas, no side effects occur, because This component is a natural result of metabolism.

Use of blood plasma for injections

When implementing the PRP method, injection of plasma, which is saturated with platelets, is used. Intra-articular administration of this component helps to significantly activate regeneration processes in tissues, stopping inflammatory changes in them.

The peculiarity of this therapeutic approach is that human plasma is a completely compatible component. Therefore, the patient will not have an allergic reaction, and no side effects will appear. One injection requires taking up to 20 ml of blood. This loss is not considered significant, although doctors recommend excluding increased physical activity.

The method used involves preliminary passage of blood through a centrifuge, as a result of which the plasma is separated. It is this element that is to be introduced into the joint area. The content of platelets in prepared 1 μl of plasma is 1 million units, although in the natural state the concentration does not exceed 200-300 thousand units. The duration of the therapeutic course is 5-7 injections with a break of 3-7 days. Subsequently, the frequency of intra-articular injections is reduced to 1 injection per year.

Doctors note that thanks to a course of injections, it is possible to postpone the moment of mandatory surgical intervention. At the same time, the volume of consumed drugs is reduced against the background of more active healing of damaged cartilage tissue. Injections can relieve pain and swelling and restore the level of joint mobility. Some disadvantages can be considered the high cost of certain drugs for intra-articular injections. However, the effectiveness of treatment is ensured at a high level with long-term preservation of the achieved effect. To avoid complications, you must contact only experienced and qualified specialists.

No. 4. What needles are used for intra-articular injections?

The choice of needle depends on the location of the affected joint. For arthrosis of the hand or other small joints, doctors select thin and short needles, similar to an insulin syringe. Injections into the shoulder or knee joint require a longer needle that will reach into the cavity. For the hip, it should be even larger, and if the patient is overweight, the instrument is selected individually.

For intra-articular injections into different joints, needles of various thicknesses and lengths are used.

What does a therapeutic blockade do?

The main effect is a reduction in pain and discomfort. Inflammation gradually goes away, mobility improves, spasm and swelling are eliminated. The result depends on many factors, including:

The effect of the active substance at the reflex level on the nervous system.
The volume of drug in the affected area.
Analgesic and anti-inflammatory effect of selected drugs.

Patients often notice noticeable improvements the very next day, as joint mobility increases and swelling decreases.

No. 7. How to give an injection into a joint?

There are several methods. There are two access points for the shoulder joint. The injection into the knee is done in one way, and if there is a need to pump out fluid, the doctor can choose one of three available points. To accurately get into the joint cavity, ultrasound is often used. This is especially important in the treatment of arthrosis of the hip joint, which has a complex configuration in itself and has difficult access.

After the injection, the patient is asked to make several movements so that the drug is evenly distributed over the cartilage surfaces. Then apply a tight bandage or cover the injection site with a sterile napkin.

There is no recovery or rehabilitation period after intra-articular injections

Advantages of intra-articular blockade of the knee or hip joint:

There is almost complete absence of pain during this type of therapy due to the use of a number of painkillers.
The effectiveness of the therapy is due exclusively to the correct selection of the drug, as well as the skills and abilities of the attending physician. If the medical institution provides the client with the services of a highly qualified specialist, an intra-articular block of the knee or hip joint will bring maximum benefit.
Safety is also an important consideration for this type of therapy. The patient must be absolutely sure that this item is provided. During the procedure, basic hygiene standards and rules must be observed. These include, for example, treating the upper layer of skin with antiseptic agents, and performing injections exclusively with a sterile disposable syringe. The skills of the specialist conducting the therapy also play an important role in the safety of the consequences for the patient’s health. Any violation of bone or cartilage tissue should be completely excluded due to the attending physician's compliance with the rules for administering injections.

Answers to questions most often asked by patients:

Is it necessary to somehow prepare for an intra-articular block?

No, therapy is carried out without preparing the patient. However, as prescribed by the attending physician, it is worth conducting additional examinations, if necessary.

Will there be any restrictions after an intra-articular block?

They will. You should not engage in any physical activity for the next 24 hours. Motor activity in the joint area accelerates blood flow, which leads to the spread of the administered drug throughout the body. To more effectively localize the drug, it is worth limiting movements in this area. It is also necessary to abandon a number of procedures that contribute to the development of an inflammatory process in the body.

What side effects should I expect after injections?

Side effects caused by intra-articular blockade of the knee or hip joint are extremely rare. This may be a manifestation of allergic reactions associated with the effects of the medication used on the body. However, it is worth noting that this issue should be taken under the control of the specialist conducting the procedure.

The process of intra-articular blockade is characterized by a short rehabilitation period. During recovery, the patient may feel pain at the injection site. In order to minimize discomfort, you should immobilize the joint if possible and apply cold to the area. If the above tips do not help, on the recommendation of a specialist, you should take painkillers.

If no positive effect is found after an intra-articular blockade, you must immediately contact the attending physician under whose supervision the procedure was carried out.

What complications can accompany the blockade process?

Among the complications after the procedure are: the introduction of various infections or pathogenic bacteria during therapy, an allergic reaction (to avoid which, before the blockade, a series of examinations are carried out as prescribed by the doctor), microtrauma of the joint capsule or the surrounding area, bleeding, nonspecific inflammation, toxic reactions. However, provided that the specialist performing the intra-articular block and monitoring the general condition of the patient is highly qualified and has a number of necessary skills and abilities, the likelihood of complications will be minimized (at the moment, complications occur in only 0.4 percent of all patients exposed to intra-articular blockade of the knee or hip joint).

Groups of drugs used for injection:

Anti-inflammatory drugs: for example, Diprospan (the drug is known for the speed of manifestation of its medicinal properties, since within two to three hours the patient will feel significant improvements).
Hyaluronic acid preparations. These include Fermatron, ViscoPlus, Sinvisc, Suplazin and so on. These medications are useful by replenishing hyaluronic acid in the body tissues, which promotes cell regeneration.
Vitamin or steroid medications.
Medicines that improve blood circulation in the body.
Local anesthetics - Lidocaine, Ropivacaine and others. These are painkillers, the effects of which are localized and long lasting (about 3-10 hours).

The choice of group and specific drug is determined solely by the attending physician, based on the individual characteristics of each patient. Also, the determination of the necessary anesthetic is carried out depending on the purpose pursued by the patient coming for the procedure of intra-articular blockade of the knee or hip joint.

No. 10. What drugs are injected into the joint and for what purpose?

There are several types of drugs that are injected into the joint for different therapeutic purposes. Anesthetics quickly and briefly relieve pain, so they are used in combination with other medications. Glucocorticoids relieve inflammation for a period of a week to a month. They can be injected into the joint no more often than 3-5 times a year.

Chondroprotectors restore cartilage tissue, and synovial fluid prostheses based on hyaluronic acid or its synthetic substitutes expand the friction surfaces. The patient's blood plasma, enriched with platelets, has a complex effect, but plasma therapy for arthrosis is not used very often due to the high cost of the method.

More and more practicing orthopedists and rheumatologists recommend this method to their patients. If injections of anesthetics are short-term, then intra-articular injections of synovial fluid prostheses provide long-term relief and relieve pain for a year and a half. The most effective drugs are those with high molecular weight, among which Noltrex occupies a leading position.

Intra-articular blockade of the knee joint.

As a rule, injections into the knee joint are used only in cases where the pain experienced by the patient is so severe that pills or other pain-relieving medications no longer help in getting rid of it.

This kind of injection does not eliminate the root cause of the pathology, however, if the course of treatment was chosen correctly, after a short period of time the patient can get rid of the pain completely. The benefit of injections is to quickly reduce the patient's pain. The speed of pain reduction is due to the local effect of this type of treatment.

Intra-articular blockade of the knee joint can be useful not only for the treatment of diseases, but also during the recovery period after surgical interventions in the area of the knee cartilage formations or other operations. The procedure in this case allows for easier rehabilitation.

In addition, injections are used for preventive purposes. They stop the processes of destruction of joints, and also in some cases contribute to the restoration of connective tissues.

Before using injections, you should consult a specialist. The reason for this is quite clear: the procedure is individual, and in some situations its use may aggravate the patient’s health problems.

Among the points that indicate the pointlessness of the type of treatment under consideration are the following:

If during the course of the disease more than half of the cartilage tissue of the joint was destroyed (this can happen with arthrosis)
If the patient has diabetes mellitus (the use of this type is permissible, but in a special dosage, which can only be determined by the attending physician who is familiar with the characteristics of the patient’s health condition)
In a situation where there is no improvement after treatment
If the consequence of arthritis is the destruction of connective tissue (namely bone and cartilage).

Indications for use are the following:

Recovery period after undergoing major surgery
The presence of a disease such as arthritis (it is advisable to use a knee joint block only for non-infectious types of this pathology)
The presence of symptoms of arthrosis, which can be characterized as an exacerbation (we are talking about the first manifestations of the disease)
Presence of periarthritis
Presence of bursitis
Other cases, if injections are recommended by a specialist.