Bursae/Joint Injections

Bursae/Joint Injections

Advanced Pain Consultants offers bursa injections to select patients needing relief from joint pain caused by bursitis, arthritis, and other inflammatory diseases. During this procedure, a mixture of a local anesthetic (numbing agent) and a steroid (anti-inflammatory medication) is injected into the inflamed joint or bursa, which has been causing pain.

A bursa is a soft, gel-filled pad that rests between the bones and muscles or tendons. There are bursae in the shoulders, elbows, hips, knees, heels, toes and other parts of the body. Their purpose is to cushion the bones and help the muscles and tendons glide over them without friction.

When the bursae become inflamed, it can cause severe pain, stiffness, swelling and other troubling symptoms. This condition is known as bursitis. The pain and stiffness can become so bad that it inhibits bodily movement. It can also cause the sufferer pain when resting, and disturb sleep.

Bursitis can be triggered by trauma, such as a fall or a sports injury, but most often it is caused by repetitive movements (such as continually waving arms off to the side) or putting pressure on joints (such as leaning forward on the elbows or kneeling). People with jobs or hobbies that require them to make repetitive movements are at highest risk. Bursitis can occur anywhere there are bursae, but most often it affects the shoulders (subacromial bursa) and hip (submaximus bursa).

An injection of steroid into a bursa can reduce swelling and inflammation, which in turn can significantly reduce pain. The injection can also be directed into an inflamed joint, to reduce pain from arthritis (arthritis is an inflammation of the joints).

Who is a good candidate?

Numerous inflammatory conditions can respond well to treatment with bursa injections, including:

  • Bursitis—in the shoulders, elbows, hips, upper legs, knees or buttocks.
  • Arthritis—in the shoulders, feet/ankles, knees, hands/wrist, elbows or hips.
  • Tendonitis—in the wrists, hands, rotator cuffs (shoulder) or knees.
  • Lateral epicondylitis (“tennis and golfer’s elbow”).
  • Plantar fasciitis.
  • Knee and elbow ligament injuries.
  • Carpal tunnel syndrome.

A bursa injection may be recommended for you if you suffer from one of the conditions noted above and your pain has not improved after undergoing more conservative pain relief measures (rest, use of anti-inflammatory medications, physical therapy, chiropractic care, massage, compression bands, etc.).

Prior to being considered a candidate for an injection, Dr. Pasi will conduct a comprehensive physical examination, which will include an assessment of your health history and medical imaging (such as x-rays or an MRI). This will help Dr. Pasi determine whether a bursa injection will meet your pain management goals.

How is a bursa injection done?

A bursa injection is performed in-office under local anesthesia and takes about 15 minutes on average. Dr. Pasi begins by numbing the patient’s skin with a local anesthetic. She then inserts a thin, hollow needle into the bursa or joint, using x-ray fluoroscopy or ultrasound imaging for guidance. Next, the treatment medication (which is a combination of a local anesthetic and a steroid) is injected through the needle. The needle is then removed, and the skin is cleansed and a bandage is applied. The patient is then sent to the recovery area for about 30 minutes before being discharged to go home.

Patients may experience some slight numbness for up to six hours after the injection. Very little, if any, recovery time is necessary; the majority of patients are able to return to work and their normal routines the same day.

How effective is a bursa injection?

There will be some pain relief immediately after the injection, but this is due to the local anesthetic that was injected and will probably only last a few hours. When the anesthetic wears off, some pain may return and last for about 2 to 3 days before the steroids start taking effect.

Exactly how long the steroids will ease the pain varies from patient to patient. Everyone responds differently. On average, most patients experience around three months of pain relief. However, some people have six or more months of relief, while others may have only a few days of relief, or none at all. Generally speaking, the patients who have the injection during the early onset of pain respond better than people who have been in pain for a long period of time before getting treatment. Patients who undergo a physical therapy or exercise program can prolong the positive effects of the injection.

For some patients, additional injections may be recommended. If, after one injection, there was some relief but not at the desired level, a second injection might be done about two weeks later to strengthen the pain relief effect.

If one injection provides the desired level of pain relief, but fades after three months, the treatment was a success and then another injection would probably be recommended. For these patients, up to four steroid injections could be done within a 12-month period (but no more than four injections, so as to limit potential negative side effects of steroid use).

If, one week after the injection and the patient has had no pain relief at all, it is unlikely the injection is going to be helpful. In that case, Dr. Pasi will not recommend a second injection. Instead, other types of pain therapies would be investigated.

Learn more about bursa injections

If you suffer from bursitis or arthritis pain and would like to find out if you may be a candidate for a bursa injection, please contact Advanced Pain Consultants to schedule an appointment with Dr. Pasi. During your consultation, she will carefully evaluate your condition to determine if this treatment is right for you, and then develop a treatment plan that is tailored to meet your specific needs and treatment goals. To book your appointment, please call (919) 510-7901.