Some orthopedic conditions are first treated with non-surgical procedures followed by surgery as the next step.

Fluid drainage

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.

Steroid injections

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 injections.

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 if necessary.

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.

Joint manipulation

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.

Joint distension

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

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 tissues.

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.

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