Injection techniques are helpful for diagnosis and therapy in a wide variety of musculoskeletal conditions. Diagnostic indications include the aspiration of fluid for analysis and the assessment of pain relief and range of motion. Therapeutic indications include the delivery of local anesthetics for pain relief and corticosteroids for suppression of inflammation and promotion of healing.
Indications for diagnostic and therapeutic injections:
- Bursitis
- Tendonitis
- Trigger points
- Ganglion cysts
- Neuromas
- Entrapment syndromes
- Fasciitis
- Myofascial pain
- Synovitis
- Inflammatory arthritis
- Advanced osteoarthritis
Joint injections
Joint injections are given to treat inflammatory joint conditions, such as rheumatoid arthritis, psoriatic arthritis, gout, tendonitis, bursitis and occasionally osteoarthritis. Corticosteroids are frequently used for this procedure, as they are anti-inflammatory agents that slow down the accumulation of cells responsible for producing inflammation within the joint space. Commonly injected joints include the knee, shoulder, ankle, elbow, wrist, thumb and small joints of the hands and feet.
While inflammation is essential defense, its purposeless presence prevents healing and, as well, it can be a bodily stressor that fatigues the inherent hormonal homeostasis. Under such circumstances, inflammation’s termination is an essential for which corticosteroid injections remain among the most important in our therapeutic armamentarium.
Nerve blocks
A nerve block results from the injection of a local anesthetic into or around a nerve.
Nerve blocks are either diagnostic or therapeutic.
Diagnostic nerve blocks provide information, helping to determine the source of the pain.
Painful conditions are treated with therapeutic nerve blocks.
Therapeutic nerve blocks can provide relief for patients who suffer from:
- Lower back pain
- Neck pain
- Sciatica
- Spinal stenosis
- Complex regional pain syndrome
- Shingles
- Cancer
- Painful peripheral vascular disease
- Migraine headaches
Pain and injury often make nerves more sensitive, so that they signal pain with less provocation. Delivering a nerve block injection allows a damaged nerve time to heal itself from a state of constant irritation which promotes the desensitization of sensory pathways. The use of local anesthetic initially interrupts the pain signals to the brain and adding a corticosteroid reduces nerve inflammation and the abnormal triggering of signals from injured nerves.
Trigger point injection
Trigger point injection (TPI) is used to treat extremely painful areas of muscle. Normal muscle contracts and relaxes when it is active. A trigger point is a knot or tight, ropy band of muscle that forms when muscle fails to relax. The knot often can be felt under the skin and may twitch involuntarily when touched.
The trigger point can trap or irritate surrounding nerves and cause referred pain — pain felt in another part of the body. Scar tissue, loss of range of motion, and weakness may develop over time.
Trigger point injection is used to alleviate Myofascial Pain Syndrome (chronic pain involving muscle and soft tissue) that does not respond to other treatments. Many muscle groups, especially those in the arms, legs, lower back, and neck, are treated by this method. TPI can be beneficial for Fibromyalgia and tension headaches.
The injections are limited to what is called the “soft tissue”(muscle and fascia) of the body. They are not given into blood vessels, nerves, joints or the spinal canal.
The injection is performed using local anesthetic and sometimes an anti-inflammatory steroid. Injection of medication inactivates the trigger point, alleviates pain and promotes healing. Sustained relief usually is achieved with a brief course of treatment. Several sites may be injected in one visit.