A number of joint diseases require not only oral medication, but also special injections. Here we are talking about periarticular introduction. This is the introduction of an injection of drugs into the periarticular tissues. That is, in the ligaments and muscles that surround the joint. What diseases are indicated for the procedure? Where exactly is the injection given? Are there any contraindications? How exactly is it carried out? We will give answers to these and other important questions in the article.
For what diseases is the procedure indicated?
Periarticular administration is the injection of certain medications, which are indicated, respectively, for pathologies of the knee joint. They can be diagnosed both in a number of rheumatic conditions, and be independent degenerative, inflammatory processes that originate in the periarticular structures.
Periarticular insertion is a procedure necessary for a number of diseases,characterized by various foci of inflammation. In particular, with the following pathologies:
- Tendinitis and tendovaginitis. In cases where tendons or tendon sheaths are inflamed.
- Bursitis. When the patient's bursa is inflamed.
- Tendobursitis. Simultaneous inflammation of both the tendon and the tendon bag.
- Ligamentitis. Inflammation of the articular ligaments.
- Fibrositis. With this pathology, the fascia and aponeurosis become inflamed.
- Myotendinitis. Inflammation of the area of muscle tissue adjacent to the tendon.
- Active arthritis. Especially with effusion in the joint cavity, which is observed in the rheumatoid form of the disease, seronegative spondyloarthritis or inflammatory processes in the connective tissues.
- Reactive synovitis of various origins. Seen in osteoarthritis, trauma, or gouty arthritis.
Where is the injection given?
Periarticular injection is, as we have already noted, an injection into the periarticular soft tissues. These include the following:
- Tendons and synovial tendon sheaths.
- Synovial bags - bursas.
- Entazis. That is, the locations where the ligaments, tendons and joint capsules will connect to the bone.
- Bundles.
- Muscles surrounding the joint.
- Aponeuroses are broad tendon plates.
- Fascia - connective tissue membranes that cover the muscles.
When performing an intra-articular injection, the specialist should pay attention to the following:
- The technique is preferably used whenthe presence of inflammatory processes in a certain location of the joint or periarticular tissues.
- If the inflammation has affected large areas, then the drug is injected mainly into focal areas.
- Such a method of treatment should be used in patients with contraindications to other methods of therapy for inflammation, pain in the joints and / or soft periarticular tissues. In particular, with diseases of the gastrointestinal tract, peptic ulcer at the stage of exacerbation, individual intolerance to certain medications.
- Intra-articular and periarticular injections are also used in case of failure of systemic anti-inflammatory treatment.
When is this treatment used?
Periarticular administration of drugs in most cases involves injections of corticosteroids - glucocorticosteroids. Such drugs have a powerful anti-inflammatory and analgesic effect. Such treatment has been effectively used for inflammatory diseases of both joints and periarticular tissues for about 50 years.
But it should be noted that the intra-articular administration of drugs is an auxiliary (less often - the main) therapy. It is prescribed due to the fact that it is possible to get a quick effect: reduce or completely remove inflammation, and with it the pain syndrome, improve or restore the function of both the joint and the limb as a whole. Similar treatment can be prescribed for the following conditions:
- Active arthritis.
- Reactive synovitis.
- Enteritis.
- Periarthritis.
- Tendinitis.
- Other inflammatory periarticular processes of various origins, except for infectious ones.
Both periarticular and intra-articular injections of drugs are widely used in the treatment of arthrological patients. Patients may be diagnosed with the following conditions:
- Rheumatoid arthritis.
- Arthrosis with synovitis.
- Peripheral arthritis.
- Gouty arthritis.
- Different kinds of periarticular syndromes.
Such a method of treatment is widely used both in hospital and outpatient conditions - polyclinic conditions. The therapy helps to reduce the terms of industrial, household disability of patients.
Safety of procedure
Complications with intra-articular injections are primarily due to the fact that generalists prescribe them to patients without a proven need. Various drugs are administered, the number of injections may be too numerous.
In cases where sessions are performed multiple times, without proper indications and contraindications, when the choice of drug or its dosage is not justified, serious consequences of this, in fact, safe minor surgical procedure, can be observed. Negative consequences are also possible if the doctor violates the technique of intra-articular injections. And also if the important rules of asepsis and antisepsis are not observed.
Absolute and relativecontraindications
An injection of hyaluronic acid into a joint is the most common example of intra-articular injections. This procedure allows you to restore mobility, freedom of movement. The fact is that hyaluronic acid not only brings the necessary fluid to the tissue, but is also able to retain it for a long time.
But both injections of hyaluronic acid into the joint and other periarticular injections have a number of contraindications that the doctor should take into account when prescribing such treatment. They are divided into absolute and relative. The first group includes the following:
- Septic infectious inflammatory processes both in the joint and adjacent tissues. Or diagnosing a patient with a common infectious disease.
- Pathological bleeding. It can be either of an endocrine nature or caused by taking medications - anticoagulants.
- "Dry joint". That is, the absence of signs of inflammation in the joint itself. The non-inflammatory nature of the pain syndrome, which can also be observed in the patient.
- Severe bone deformity, destruction of the joint. In particular, this is a sharp narrowing of the joint spaces, ankylosis. Or joint instability, which could be due to arthritis.
- Aseptic necrosis of the epiphyses of the bones that form the joint, as well as periarticular osteoporosis in a pronounced form, through the articular fracture of the bones.
For intra-articular injections for arthrosis, there are several relative contraindications:
- Severe condition of the patient.
- Short-term effect or completeineffective after two similar injections.
Carrying out the procedure
If we analyze the technique of intra-articular injections, we will see that the procedure begins with a thorough preparation:
- Getting the patient a general diagnosis (if not already done).
- Assessment of local status - articular and periarticular.
- Determination of indications for the introduction of such injections.
- Determination of the absence of contraindications to the local use of glucocorticosteroid preparations.
- Determining the location where the drug will be injected.
- Mandatory informing the patient about the procedure, obtaining written consent from him for its implementation.
- The choice of drug for treatment in an individual case.
- Determination of drug dosage.
- Scheduling procedures and determining their multiplicity.
- Actually, the procedure.
What drugs are used for an injection into the joint with arthrosis of the knee joint? We list the most common medications and indications for their use.
Drugs for pronounced local inflammation
If the patient notes a pronounced pain in a particular joint, he may be shown a long-term glucocorticosteroid. Medicines are also applicable to patients with chronic rheumatic pathologies.
In particular, periarticular administration of "Diprospan" (betamethasone) can be prescribed. This drug has the following properties:
- It contains both fast and slowly soluble s alts.
- It has both a fast and a prolonged effect on the inflamed area. So the patient feels the first effect of the drug within 1-3 hours after the injection. The anti-inflammatory and analgesic effect of "Diprospan" remains for up to 4-6 weeks.
- Does not cause local crystalline reactions.
- Does not have a local dystrophic effect on adjacent tissues.
The drug can be used for both intra-articular and periarticular administration. In particular, it is prescribed for arthritis, bursitis, periarthritis, secondary synovitis, etc.
"Diprospan" is also good in that it can be prescribed to patients both once and, if indicated, again.
The next category of drugs that are used for injections into joints and nearby tissues for local pain are "Trikort", "Kenalog". In their regard, it is important to highlight the following:
- The duration of analgesic and anti-inflammatory effects on tissues reaches 3-6 weeks.
- It is noted that 6-12 hours after the administration of the drug, microcrystalline short-term inflammation of the joints may occur. The doctor must warn the patient about such a side effect.
- The drug is characterized by a pronounced local dystrophic effect. It can reach localized atrophy of the skinintegument, tendons or nerve trunks with repeated administration of the drug.
- These funds can only be used for injection into the cavity of the bursa or joint. It may be indicated in arthritis, bursitis and synovitis.
- For periarticular administration in soft periarticular tissues, these drugs are not intended.
- Medics do not recommend using "Kenalog" and "Tricort" for re-introduction into the joints of the hands. This is fraught with the appearance of a cosmetic side effect - skin atrophy. Therefore, in this case, drugs are not prescribed to children and women.
Medicines for moderate local inflammation
Let's analyze which injections into the joint with arthrosis of the knee joint can be prescribed if the patient notes not a bright, but a moderate pain syndrome. "Metipred" will be shown. The tool has the following characteristics:
- It has a moderate analgesic and anti-inflammatory effect. The duration of the effect of the drug in this case is 1.5-2 weeks.
- In certain cases, 1-3 hours after the injection of the drug, there is a short-term microcrystalline local inflammation of the joint.
- The drug does not have a local dystrophic effect on nearby tissues.
It is recommended to prescribe Metipred for both intraarticular and periarticular administration. Suitable for both single and repeated injections. The greatest effectiveness of the drugobserved with moderately severe inflammatory processes (accompanied by the same moderate pain). It is prescribed for various rheumatic conditions, as well as post-traumatic reactions of the body.
Drugs for mild local inflammation
Now let's consider what drugs are used for intra-articular injections in the shoulder joint, knee in the case when the patient notes moderate or mild pain. In particular, this is possible with arthritis, bursitis, secondary synovitis, inflammatory processes in the periarticular tissues. In these cases, a short-acting drug, hydrocortisone acetate, is used. We list its characteristic features:
- It has a weaker, sparing effect than the above funds.
- Duration of drug effect lasts up to 1-1.5 weeks.
- May cause local microcrystalline inflammation of the joint for a short time, which the doctor should warn his patient in advance.
- Local dystrophic effect when referring to this drug is not caused.
- Available for both single use and reuse.
Required dosage
How to do intra-articular injections? After the specialist decides on the drug, he must prescribe an individual dosage of the drug for the patient. This primarily depends on the location where the injection will be given. The options here are:
- Large joints. For example, knee or shoulder. One dose givenfacilities. Usually this is the contents of one vial, ampoule.
- Hip joint. It is important to note that injections of glucocorticosteroids into this location should be administered only if there are absolute indications. The procedure is performed in a hospital setting. It is advisable to entrust it to an experienced specialist.
- Medium joints. These are elbow, wrist and ankle. As for the dosage, it is permissible to administer no more than 1/2 of the dose of the drug.
- Small joints. The category includes interphalangeal, as well as metatarsophalangeal, metacarpophalangeal. It is administered once no more than 1/4-1/5 of the dose of the drug chosen by the doctor.
Treatment scheme and frequency of procedures
As for a single procedure, in this case, it means the introduction of the drug:
- In one large joint.
- In two middle joints.
- Three to five small joints.
The multiplicity is determined by the attending doctor individually for each patient. In particular, the effectiveness of the previous administration of the agent is evaluated, and the necessary indications for repeating the procedure are found.
But it should be noted that the introduction of glucocorticosteroids intra-articular or periarticular way in the form of a course is categorically unacceptable. If after the first injection a short-term or insufficient effect was observed, then repeated administration is possible after 4-5 days. If it turned out to be insufficiently effective, then the introduction of the drug into the joints or periarticular tissues must be completely abandoned.
Regardingthe interval between repeated injections, then its very minimum length depends on the intensity of the impact of the agent used:
- Strong drugs: 1-2 months.
- Average: 2-3 weeks.
- Short-term drugs: 5-7 days.
If these intervals are not met, then this is fraught with the following negative effects:
- Development and strengthening of dystrophic processes occurring in cartilage or bone.
- Development of aseptic tissue necrosis.
Features of the procedure
The introduction of GCS into the joint or periarticular tissues is carried out only after the above preparation for the procedure. The specialist should also pay attention to the following:
- If the patient has increased psycho-emotional activity, then before the joint injection, Relanium is additionally administered subcutaneously.
- Injections into the small joints of the limbs are quite painful, which the doctor must warn the patient about.
- If there must be an effusion, then before the introduction of a glucocorticosteroid, the specialist must evacuate the inflammatory fluid present there from the joint cavity.
- After the procedure (especially if the injection was made into a load joint), the patient should ensure the maximum possible rest of the limb for 3-4 hours.
Injection should only take place in a specially equipped treatment room withaseptically clean dressing room. Before the procedure, the patient must remove clothing that interferes with manipulation, collect long hair, remove street shoes before entering the office.
Syringes for intra-articular injections are single-use, sterile. Their capacity is standard - 5, 10, 20 ml. As for the diameter of the needles, two variations are used here: 0.5-16 mm and 0.8-40 mm. Atraumatic disposable needles can also be used optionally.
The doctor must carry out the procedure in disposable medical gloves. After each patient, he carefully treats them with alcohol. Accordingly, the specialist must master the technique of intra-articular and peri-articular administration of corticosteroids. The doctor undergoes appropriate training, his qualifications are confirmed by a certificate.
The doctor may be assisted by a nurse during the procedure. They are dressed in clean robes, masks and hats. As for the patient, before the procedure, he must first take a shower, put on clean underwear. If necessary, the injection site should be clean-shaven.
Feedback on the procedure
If we turn to reviews of intra-articular injections, they will be heterogeneous. It can be concluded that the effect of the same glucocorticosteroid drugs in this case is individual. Some patients note their effectiveness, some admit that they did not feel the proper relief.
There are many cases when the injection itself caused a strong pain effect. SomeThe procedure did not cause complications in patients. If we turn to medical statistics, we will see that a local analgesic and anti-inflammatory effect can be achieved in 85-90% of cases of intra-articular and peri-articular injections. At the same time, 50-70% of patients fully restore their ability to work after 1-2 such injections of GCS.
Periarticular injection involves intra- and periarticular injections. It is important to note that the procedure is prescribed only for absolute indications. The specialist should pay special attention to the choice of a certain type of drug, the appointment of its dosage and the establishment of the frequency of use.
