Understanding Joint and Soft Tissue Injections

Joint and soft tissue injections are elective in-office procedures that are done by licensed medical professionals. The most common reason that joint and soft tissue injections are performed is to relieve pain in specific joints or muscles. However, joint and soft tissue injections may also be done prophylactically. There are medicinal substances that may be injected into joints and soft tissue in an attempt to prevent further joint deterioration and/or episodes of musculoskeletal pain and tension.

The most common joint injection is a corticosteroid injection. Corticosteroids are potent anti-inflammatory agents that can be injected directly into the joint. This may be done to relieve joint pain and inflammation in rheumatoid arthritis patients. Corticosteroid joint injections may also be helpful in a subtype of osteoarthritis known as inflammatory osteoarthritis.

Corticosteroids, such as prednisone, may also be injected into soft tissue as an in-office procedure. Corticosteroid injections are particularly helpful when administered to the anterior wrist in individuals who have carpal tunnel syndrome that has not resolved following first line therapy with a wrist brace.

Other common and effective soft tissue injections include trigger point injections and Botox muscle injections. Trigger point injections are commonly done for fibromyalgia, myofascial pain, and back pain associated with palpable trigger points. A practitioner may choose to inject lidocaine, a rapid numbing agent, or sterile saline directly into the trigger point.

Botox soft tissue injections utilize the botulinum toxin. These injections are only done in select patients. One FDA approved use of Botox is for the condition known as cervical dystonia, also called torticollis. This condition results from spasm of neck muscles that cause an individual to have their head tilted to one side. Botox is injected directly into the neck muscles that are spasming.

Botox is also used in individuals who have clonus, an often chronic severe tension of one or more groups of muscles. People often have clonus, or spasticity, due to disease of the central nervous system though it is also seen in rare conditions such as some of the inherited mitochondrial disorders. Individuals with cerebral palsy or severe head trauma may have chronic muscle spasticity that responds well to Botox injection. As with cervical dystonia, the Botox solution is injected directly into the spastic muscles.

A series of injections are often required for both trigger point and botox injection. This may be done to achieve full efficacy of these medications but also to prevent return of, or worsening of, the treated medical conditions. Steroid joint injections are occasionally done with a similar preventive intent, as are hyaluronic acid injections into joints.

There are a variety of joint and soft tissue injections that may be done as simple in-office procedures. Many patients may find that these injections are particularly effective at relieving painful conditions. Individuals should work with their physician to determine if joint and/or soft tissue injections are right for them.

Source: Fowler, G., Pfenninger, J. Procedures for Primary Care. 2nd Ed.