Injections

I use injections frequently in the office treatment of my patients. Injections can be used to treat a problem, by putting medicine in a particular joint or body space. Injections can also be used to help diagnose what a problem is or where it is located. Often I will use injections to accomplish both diagnosis and treatment of a problem.  I will often give injections for Arthritis or Joint pain, and for Morton's Neuromas.

Treatment By Injection
Cortisone is a powerful anti-inflammatory medication that can be injected into joints, around tendons or around nerves to relieve pain. Many conditions can be effectively treated with intermittent cortisone injections. You should generally not have cortisone injections into an area more frequently than every 3 months.

I use a cortisone preparation called Kenalog-40 (Triamcinolone Acetonide injectable suspension 40mg/ml).

The injection is always given together with local anesthetic, a mixture of Marcaine (Bupivicaine 0.5%) and Lidocaine HCl 1%.

I first inject the local anesthetic, which will sting for a few seconds. Then the cortisone is injected.

The area of the injection should remain numb for 5 – 6 hours while the local anesthetic is in effect. Sometimes the cortisone may cause soreness for a few days. The cortisone may not cause a good effect for several days.

If cortisone injections are given too frequently it is possible to damage joint cartilage or the connective tissue (ligaments, tendons). Some people can get permanent patches of whiteness in the skin in the area of a cortisone injection.

Injections for Diagnosis
Injections can be helpful to determine a precise location of pain, and what can be causing the pain. There is not a radiographic study or other test that pictures pain. But, if an injection will relieve pain for a period of time, that is a good indication that the site of the injection is the location that is painful.

I will ask you to keep track of how your foot or ankle feel during the 5 – 6 hours after the injection. I will ask you to tell me on your next visit:

If the pain is relieved during that time, that indicates that the spot where I gave the injection is where your pain coming from.

If the pain is not relieved during that time, that indicates that the pain is coming from a different spot.

You may want to write down how the injection makes the pain feel during those 5 - 6 hours of numbness, so you can tell me accurately when you report back.