Hip / Knee / Shoulder

Hip Injections

Hip joint injections involve injecting medicine directly into the hip joint to diagnose the source of pain or treat pain due to conditions such as arthritis, injury or mechanical stress of the hip joint. Hip pain may be experienced in the hip, buttock, leg or low back. The injection contains a combination of a numbing medicine and cortisone (an anti-inflammatory agent). Numbing medicine delivers temporary relief from pain, provided the hip joint is the source of the pain. It thus serves a diagnostic function and helps to confirm or deny whether the joint is the source of pain. Cortisone serves to reduce the inflammation in the joint providing long term pain benefit.

Procedure

If needed, a relaxation medicine is given to the patient through an IV line. The patient lies face down on an X-ray table. The small area where the injection needs to be given is numbed with an anesthetic. The patient may feel a sting for a few seconds. A small needle is then accurately placed by the doctor into the joint guided by the real time X-ray images (fluoroscopy). Before injecting the medicine, a contrast dye is injected through this needle into the joint to confirm that the medicine will reach the joint. A combination of anesthetic and anti-inflammatory cortisone is then slowly injected into the joint. The whole procedure usually takes about 30 to 60 minutes.

After the procedure

After the injection the patient is made to rest for 20 to 30 minutes and is then asked to move the joint, provoking pain. The patient may or may not find a decrease in pain depending on whether the injected joint is the main source of the pain. The patient is also asked to maintain a record of relief in pain during the coming week. Physical therapy may also be recommended. Even when pain relief is significant the patient should increase activities gradually over one to two weeks to avoid reappearance of pain.

Risk and complications

The possible risks of hip injections include: swelling and pain in the joint after the injection, infection, depigmentation of skin, local thinning of the skin and rupture of a tendon.

If the injected hip joint is the source of the pain, the pain may reduce two to five days after the injection. However, if no improvement is found within ten days after the injection further diagnostic tests may be required to ascertain the cause of pain.

Knee / Shoulder Injections

Ultrasound is a common imaging technique that employs high frequency sound waves to create images of organs and other internal structures of the body. These images provide valuable information of underlying pathology of the tissues and assists with diagnosis and planning the treatment of a particular condition. Ultrasound provides a clear view of the organs, tendons, muscles or joints and any associated disorders.

Ultrasound guided injection is a minimally invasive procedure used for treating various musculoskeletal painful conditions such as tendonitis, bursitis and neuritis or to perform cyst aspiration. It is also an excellent tool for guiding the placement of needles for both diagnostic as well as therapeutic purposes.

Injection of a pain medication in combination with a local anesthetic directly to the site of injury helps to relieve pain. The advanced imaging of ultrasound provides high resolution images that enable the physician to precisely locate the injections deep into the target tissue without harming surrounding tissues.

Procedure

The procedure is used for diagnostic as well as therapeutic purposes. Anti-inflammatory medications such as corticosteroids and hyaluronans are the most commonly used medications to relieve pain, inflammation and swelling or to stimulate synovial fluid production to improve lubrication.

Shoulder joint injection technique

Shoulder joint injections are commonly used for certain conditions such as osteoarthritis, frozen shoulder, or tendonitis. The administration of the injection to the shoulder joint depends upon the condition to be treated. The approach for application of the injection may be anterior, posterior, superior or inferior aspect of the joint.

During an ultrasound guided injection, the patient will be asked to lie or sit down on a table depending on the site of the injection. A clear water based conducting gel is applied over the skin to assist with transmission of the sound waves. The doctor moves a hand held probe, called a transducer, over the targeted area. The transducer emits sound waves and detects the rebound echoes from the tissue. Images are created from these sound waves and can be viewed on the video display screen attached to the scanner. The waves provide a clear view of the targeted area and helps the doctor locate the correct site for injection.

Knee joint injection technique

Knee joint injections are frequently used for knee conditions such as osteoarthritis, baker’s cyst or knee bursitis.

During the administration of the injection the patient will be positioned lying down and a clear water based conducting gel is applied over the targeted site. The gel is used for transmission of the sound waves to deeper structures. The doctor moves the hand held transducer over the targeted area to provide images of internal structures. Under the guidance of ultrasound, the doctor inserts the needle into the skin to reach the targeted location. The procedure can be used for injecting medications or to aspirate fluid from the affected tissue.

Risks

Ultrasound guided injection is a relatively safe and painless procedure. Some of the associated complications include bleeding at the site of insertion, and injury to adjacent structures. Patients can resume their normal activities immediately after the completion of the procedure.