Individuals suffering from joint and soft tissue injuries or inflammatory disease conditions of the joints may initially respond to routine measures such as rest, physical therapy, or medication. However, if these measures fail to provide improvement, alternative measures like joint and soft tissue injections may be the next step recommended.

An injection may prove not only less painful but also more effective than other measures because the needle will be able to reach and deliver drugs more precisely to the inflamed or painful site.

Injections are shots of medicine given by the doctor into a joint space, such as the knee, or into a soft tissue space, like the area between a muscle and a bone. Injecting into a joint is called “intra-articular” injection while injecting near a joint is called a “peri-articular” injection, or soft tissue injection.

Joint and soft tissue injections are often given as part of the diagnosis and/or treatment of musculoskeletal conditions. Diagnostic indications include joint aspiration, which involves inserting a needle into the joint space, and drawing out fluid. It is then examined under a microscope to determine causes that may include infection, inflammation, or trauma.

Once a diagnosis has been made, therapeutic treatment may include delivery of local anesthetics for pain relief and injection of drugs such as anti-inflammatory agents or steroids for the relief of pain and/or suppression of inflammation in the joints or soft tissue spaces.

Diagnosis

The doctor will most likely first take a detailed history, then examine the site and inquire about the severity of pain. The doctor will also ask for a history of any known allergies to medications. The doctor will then perform a detailed physical examination to assess the parameters and severity of the pain and to determine if the inflammation is in the muscle, tendon, or joint.

The doctor identifies trigger points for pain by appropriate palpation skills; in other words, the doctor touches different parts of the body and has the patient indicate pain levels via verbal feedback. He or she may also order X-rays of the joint in order to rule out a bone fracture. A blood test may also be performed to diagnose chronic inflammatory conditions that are sometimes responsible for pain and inflammation in the joints. The doctor will then decide on the appropriate medicine and its dosage to be administered during the injection procedure.

An individual may need joint and soft tissue injections if they suffer from one or more of the following conditions:

 • Bursitis

 • Carpal tunnel syndrome

 • Frozen shoulder

 • Gout

 • Rheumatoid arthritis

 • Osteoarthritis

 • Myofascial pain syndrome

 • Tennis elbow

 • Tendinitis

 • Plantar fasciitis

Most of the time, the patient undergoes the procedure only after other previously prescribed treatments such as rest, physiotherapy, or medication have proven ineffective and do not provide any relief from the symptoms.

The doctor will first cleanse the area with either betadine or another antiseptic solution to reduce the risk of infection. Then, he or she will administer a local anesthetic, or numbing medicine, at the site of injection to lessen the pain that would normally be felt during the procedure.

Next, the doctor will insert the needle into the joint. With the local anesthesia administered, the individual may experience some pressure when the needle is inserted, but the area will be numb to major pain.

In the case of a diagnostic procedure, as discussed previously, fluid from the joint may be extracted from the site. When an injection is performed as a therapeutic measure, the desired medication is injected into the joint or soft tissue space and an adhesive dressing is placed at the injection site after the procedure.

Side Effects

One of the most common side effects of a joint and soft tissue injection is a post-injection flare up, or initial inflammation, after an injection. The irritation and swelling of the tissues may persist for about 48 hours.

Less common side effects include infection, rupture of the tendon, and muscle damage. Therefore, post-injection, it is important for the person to keep the injection site clean and seek medical care if they notice an increase in the pain, redness, or swelling at or around the site of the injection that lasts for more than 48 hours.

Occasionally, some individuals cannot stand the pain of an injection in the joint or soft tissue space. In these cases, there is more pain caused by the injection than from the original disorder. It is for this reason that many physicians will utilize other methods first, such as medication, osteopathic manipulative treatment, or physical therapy, before recommending joint injections.

Once the effect of anesthesia wears off, the patient may experience a bit of pain. Applying ice to the area for 15 minutes several times a day and/or taking an oral pain reliever pill as recommended by the doctor, may help in relieving pain.

Suggested strategies for recovery include resting a weight-bearing joint as much as possible and avoiding strenuous exercise for the first one to two days after an intra-articular injection.

Benefits

After a joint or soft tissue injection procedure, there can be immediate results. In the case of inflammation of, for example, an arthritic knee or elbow, there is a noticeable and rapid reduction in joint pain and restoration in functionality of a previously immobile body part. Steroids not only decrease the inflammation in the injected joint, but they also improve diseased joints throughout the body.

The relief of localized inflammation is more rapid and powerful with an injection procedure as compared to a general, oral anti-inflammatory medication. An injection can also prevent side effects such as irritation of the stomach that accompanies many oral anti-inflammatory medications. If these injections are administered properly, an individual can gain relief from pain and inflammation for months and even years. These injections can also permanently cure diseases such as bursitis and tendonitis where the tissue inflammation is localized to a small area.

If the individual is undergoing physical therapy, they may be advised to undergo more intensive mobilization treatment if the injection is successful in reducing or eliminating pain and stiffness.

Need for reinjection in an individual usually depends on their previous response to the first injection. Most patients usually respond well and achieve significant benefit after the first injection. A second injection in these patients is only needed if there is a recurrence of symptoms. Additional injections are not recommended in patients who gained no relief or functional improvement after two injections, because there is a low possibility of a different outcome.

An injection may be repeated every three to four months if the patient is achieving therapeutic benefits and other treatments are still proving either inappropriate or ineffective. However, it is a general rule to avoid injecting steroids into the same joint more than three times to avoid damage to the cartilage.

Outlook

Injections of the joint and soft tissue are not only relatively safe procedures that are used for diagnosis, but they are also used for treatment of a wide variety of musculoskeletal conditions. These injections are of particular benefit in cases of joint or tissue injury and inflammation because they provide the following benefits with minimal side effects:

• Rapid pain relief

• Reduction in inflammation

• Restoration of function and mobilization of the affected joint

Joint and soft tissue injections are a useful treatment, especially when used in combination with other pharmacologic and rehabilitation measures, such as the administration of pain relief medications, physiotherapy, massage, and the employment of ice and heat.