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Intraarticular injections of medicines

They usually involve the knee and shoulder joint where they are the most common problems of pain and dysfunction. The medications we use are local anesthetics, cortisone, hyaluronic acid.

Osteoarthritis of the knee

It is the most common condition. It is due to the progressive degeneration of the articular cartilage until its final destruction (final stage), where total arthroplasty is indicated.

Patients who are in intermediate stages of the disease and do not benefit from drugs or have a contraindication for them (simple analgesics, anti-inflammatory), or do not want to undergo surgery or cannot due to an aggravated general condition, can be relieved with intra-articular administration of drugs. Hyaluronic acid has provided significant relief from the pain of knee osteoarthritis and has provided a solution to many , especially elderly, patients.

 To begin with, hyaluronic acid is a substance that is naturally contained in articular cartilage and synovial fluid. Its usefulness lies in the fact that on the one hand it lubricates the joint ,thus reducing friction and wear and tear of movement, on the other hand it absorbs the vibrations from the loads on the joint. In patients with osteoarthritis, hyaluronic acid is reduced in the affected joint. Studies have shown that injecting hyaluronic acid into the knee joint brings significant pain relief because it lubricates the joint, reduces friction, and increases shock absorption. It also has anti-inflammatory action, and causes the body to synthesize increased amounts of hyaluronate on its own. It also appears to have an advantage over cortisone, as studies have shown that its action lasts longer and lacks the side effects of the latter.

There are various formulations of hyaluronic acid, most of which require one injection every week for 3-4 weeks, while recently, higher concentration formulations are available that require fewer injections and therefore less discomfort for patients. The results of the treatment are evident from 4η week , are maximised at about 12η , and last up to 10-12 months, and may be repeated.

The treatments are done in our clinic and are painless. The patient is lying down and relaxed and after the knee is examined and the guide points are palpated, a meticulous antisepsis of the area is applied, and the whole procedure is done under strictly aseptic conditions and takes a few minutes. The patient is advised not to strain the knee for 1-2 24/hours, some side effects , such as pain from the injection, some swelling, and redness are transient and the patient can cope with them by placing an ice pack.

Contraindications are known allergy to the drug, active inflammation of the skin of the area and taking anticoagulant drugs (it is necessary to stop taking them for a few days).

Shoulder arthropathy

The shoulder area consists of two joints, the scapulohumeral joint (between the humerus and the scapula), and the acromioclavicular joint (between the scapula and the clavicle). The most common conditions that are indicated for intra-articular treatment are joint inflammation (bursitis), scapulohumeral periarthritis, rheumatoid arthritis, severe rest pain, and shoulder pain with reflection in the area behind the ear , combined with limited shoulder mobility (acromioclavicular joint). The injections can be done safely in the office, do not take long and the patient can return home immediately afterwards. Injection into the shoulder joint is done either by an anterior or posterior approach (photo). In the anterior approach the patient is seated with the affected arm hanging freely, while in the posterior approach the patient is again seated with the affected arm hanging in slight abduction and inward rotation. Before the injection, the area is always disinfected very thoroughly to avoid septic arthritis. The injection at the acromioclavicular joint is made with the patient again in a sitting position, and the joint between the clavicle and the acromion of the scapula is palpated, and the needle is directed vertically, after thorough antisepsis of the area. This joint has a small volume and therefore a very small amount of drug is administered, and 25% of patients report a transient increase in pain after the injection, which is reported in advance. After the end of the infusion, pressure is applied to the sites for a few minutes to avoid haematoma.

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