At the Joint Injection Clinic we use a variety of different injections to treat musculoskeletal issues. These include steroid, platelet rich plasma, hyaluronic acid/viscosupplementation, prolotherapy, high volume and hydrodilatation procedures.
PLATELET-RICH PLASMA (PRP)
PRP is a novel technique that utilises a patient's own blood. A small sample of blood is taken from an arm vein and centrifuged to separate the platelet-rich layer from the red blood cell layer. The platelet-rich part, containing concentrated growth factors is then injected, under ultrasound-guidance to the specific anatomical site. There is mounting evidence to support the use of PRP injection for mild-moderate knee arthritis.
Steroid injections are used to reduce inflammation and the pain associated with it. They have widespread use in the treatment of osteoarthritis but have limitations and recent evidence has resulted in clinicians using steroids more cautiously for certain conditions, i.e. tennis elbow/plantar fasciitis. Steroid injections can be helpful as a temporising measure to reduce pain in order to facilitate rehabilitation but can also effectively treat certain issues such as frozen shoulder (Adhesive capsulitis) and wrist tendon sheath inflammation (De Quervain's Tenosynovitis).
Prolotherapy involves the use of concentrated glucose, usually diluted with local anaesthetic, which acts as an irritant solution. This solution creates a local inflammatory response and is used to treat ligament laxity and can help to stabilise joints. It can also be used to treat conditions such as 'tennis elbow'.
HYALURONIC ACID (VISCOSUPPLEMENT)
Hyaluronic acid (HA) is a substance similar to synovial fluid, which occurs naturally in joints and acts to lubricate and protect against shock and stress. HA is commonly used for conditions such as knee and hip arthritis, in order to reduce pain, improve function and facilitate rehabilitation.
Hydrodilatation refers to a procedure where a relatively large volume of fluid is injected into a joint, as a way of mechanically stretching the tissue to improve the range of movement. This procedure is used almost exclusively for the marked restriction seen with frozen shoulder (adhesive capsulitis) and can an be an effective way of allowing the patient to regain range of movement while also significantly reducing pain.
HIGH VOLUME INJECTION (HVI)
A High Volume Injection can be used to treat tendinitis/tendinopathy of the large lower limb tendons (Patellar and Achilles). The procedure involves infiltration of fluid into the interface between the tendon (Achilles or Patellar tendon) and the adjacent fat pad. This is thought to disrupt the ingrowth of blood vessels/nerves seen in tendinopathy and therefore have an effect on pain and local sensitivity.