Some orthopedic conditions are first treated with non-surgical
procedures followed by surgery as the next step.
Your doctor may drain the fluid from the knee joint using a needle. This
is called needle aspiration and is often performed under ultrasound
guidance. This is treatment for conditions such as Baker’s Cyst.
Injecting corticosteroids along with an anesthetic into your joint may
help decrease pain and improve mobility, especially in the early stages
of the process, particularly for the shoulder joint or for conditions
such as bursitis. This is a simple and effective treatment that can be
done in the doctor's office. It involves a single injection into the
bursa. The injection may provide temporary (months) or permanent relief.
If pain and inflammation return, another injection or two, given a few
months apart, may be needed. It is important to limit the number of
Ultrasound Guided Injections
This outpatient procedure is designed to provide relief for patients
with arthritis of the knee, and allows the physician to inject an
inflammation-reducing steroid with maximum accuracy. The knee is first
numbed, then uses an ultrasound probe to position the needle and guides
it into the problem area using the ultrasound imagery. The medication is
then injected into the joint. The local anesthetic and steroid solution
in the knee joint will reduce inflammation and pain, and can be repeated
Bracing, booting and casting
Some injuries need to be immobilized before other nonsurgical or
surgical treatment is indicated. Achilles tendinitis, and ankle sprains
are treated with immobilization.
In this procedure, you receive a general anesthetic, so you'll be
unconscious and feel no pain. Then the doctor moves your joint in
different directions, to help loosen the tightened tissue.
Injecting sterile water into the joint capsule can help stretch the
tissue and make it easier to move the joint.
Viscosupplementation for Treatment of Arthritis
Viscosupplementation is a therapeutic option for individuals with
osteoarthritis, the “wear and tear” kind of the knee, who have a
lower-than-normal concentration of hyaluronic acid in their joints. In
this procedure, a gel-like fluid called hyaluronic acid is injected into
the knee joint. Hyaluronic acid is a naturally occurring substance found
in the synovial (joint) fluid. It acts as a lubricant to enable bones to
move smoothly over each other and as a shock absorber for joint loads.
During the procedure, if there is any swelling in your knee, your doctor
will remove (aspirate) the excess fluids before injecting the hyaluronic
acid. Usually, this can be done at the same time, with only one needle
injected into the joint, although some doctors may prefer to use two
separate syringes. Depending on the product used, you will receive one
to five shots over several weeks.
Physical therapy may be part of your ongoing treatment for a chronic
orthopedic condition such as arthritis, or part of your recovery after a
surgical procedure. The goal of all physical therapy is to reduce pain
and swelling and improve or restore physical function or fitness. This
may involve exercises to increase flexibility, strength, endurance,
range of motion, coordination and balance, as well as other techniques.
Extracorporeal shock wave therapy (ESWT)
ESWT is a noninvasive solution for conditions that are not helped by
anti-inflammatory or immobilization devices. The procedure uses low-dose
sound waves applied to targeted areas to reduce pain and stimulate the
damaged tissue cells to rebuild.
Platelet-Rich Plasma Treatment
One of the newest treatments for various orthopedic problems and
injuries ranging from sprained knees to chronic tendon injuries is
platelet-rich plasma. It is now being used to treat Achilles tendonitis,
Jumper’s knee—another tendon injury, acute ligament and muscle injuries
such as a pulled hamstring in thigh and knee sprains, Knee arthritis,
Fractures, and even in some surgical procedures. Blood is mainly a
liquid called plasma, as well as solid components that include red
cells, white cells, and platelets. The platelets are best known for
their importance in clotting blood, and also contain hundreds of
proteins called growth factors that are very important in the healing of
injuries. PRP is plasma with many more platelets than are typically
found in blood. The higher concentration of growth factors can
potentially speed up the healing process. PRP can be injected into the
injured area. For example, with Achilles tendonitis, a condition seem
commonly in tennis players and runners, the heel cord becomes swollen,
inflamed and painful. A mixture of PRP and anesthetic is injected
directly into the inflamed tissue. PRP can also be given after surgery
for some injuries. A torn heel cord may need to be surgically repaired,
and healing possibly improved with PRP that is stitched into the torn
Facet Joint Injections
The facet joints, found on both sides of the back of the spine, can
become irritated and inflamed and cause pain. During the procedure, the
doctor numbs the skin and tissue above the facet joint with an injection
of local anesthetic. An x-ray device called a fluoroscope helps the
doctor guide the needle through the numbed tissue into the facet joint,
and contrast dye is injected into the joint to confirm placement. Once
the needle is positioned properly, a mixture of anesthetic and
anti-inflammatory steroid medication is injected in one or more facet
joints. Up to three injections may be given per year to reduce pain and
inflammation in the neck and back.
Cervical Epidural Injection
This procedure relieves pain in the neck, shoulders and arms caused by a
pinched nerve or nerves in the cervical spine. Conditions such as
herniated disc and spinal stenosis can compress nerves, causing
inflammation and pain and the medication that is injected reduces
swelling of the nerves. Intravenous sedation may be given and the region
of injected numbed with local anesthetic. Using x-ray guidance with a
fluoroscope, the larger needle is guided into the epidural space in the
neck—the region through which the spinal nerves travel. Then a contrast
dye is injected into the space to ensure the needle is positioned
correctly near the affected nerve or nerves. The mixture of anesthetic
and steroid solution is injected into the epidural space to decrease the
swelling of the nerves and relieve pressure. Some people may need only
one injection, and others two or three spaced weeks apart to provide
significant pain relief.
Lumbar Epidural Steroid Injection
This injection helps relieve lower back and radiating leg pain from
swelling and inflammation from spinal conditions. A local anesthetic is
used to numb the skin and tissue along the lumbar vertebra bone. Using a
fluoroscope for guidance, the doctor slides the needle toward the
epidural space between the affected vertebrae and injected a contrast
dye to confirm the correct location of the needle tip. Then the
steroid-anesthetic mixture is injected into the epidural space, bathing
and soothing the nerve root. The procedure can be repeated up to three
times to provide relief from pain and swelling.
Lumbar Sympathetic Block
This helps relieve leg pain caused by complex regional pain syndromes
tat develop after an injury to a joint or limb. Usually a series of
injections with a mixture of anesthetic, saline and anti-inflammatory
solution is injected around the sympathetic nerves to block the pain
signals before they reach the brain. These injections can be given once
a week until the pain subsides.
For more information, call 1.866.CALL.MLH.