KNEE, HIP & SHOULDER JOINT PAIN
These three joints are the larger joints of the body with knee pain the most common joint problem. The following will discuss the causes and treatments for these different pain problems.
STEROID injections are commonly done for osteoarthritis of these joints as well as for bursitis and tendonitis. Steroid injections into the joints do decrease inflammation of the joints. However, there is growing concern that they may cause further damage to the already thinning cartilage within the joints. Common bursitis problems are Pes Anserine (inferomedial knee), Trochanteric (lateral hip), Ischiocrural (hamstring area), Subacromial/Subdeltoid (anterior or lateral shoulder), and Scapulothoracic (medial shoulder blade). Common tendon problems are the patellar (knee), gluteus medius and hamstring (hip), the biceps and rotator cuff (shoulder).
Hyaluronic acid with trade names Orthovisc, Synvisc, Supartz are most commonly injected for arthritis of the knees as this is the only joint that insurances approve. They can also be injected into the hip and shoulder, but would be for cash pay patients only. These are a gel-like substance that when injected allow the joint to make its own synovial fluid better, providing better cushion. They are typically done in a series of 3 injections and often repeated every 6-12 months. They can delay or prevent the need for total joint replacement.
RadioFrequency Ablation of the joint nerves can be considered for end-stage arthritis, Avascular Necrosis of joints, and post-surgery; including after total joint surgery. This has been most successful for the genicular nerves of the knee.
NERVE STIMULATION techniques including both Peripheral Nerve Stimulation (see PNS section) and Dorsal Root Ganglion stimulation (see DRG section) may be considered for joint pain and especially when one develops CRPS of the joint area after surgery or spraining the joint.
Platelet-Rich Plasma It is not covered by sureties. It is often done for sprains of the knee, which are microtears of the collateral ligaments. Also commonly done for tears of the meniscus in the knee and/or tears of the anterior or posterior labrum of the hip or shoulder, respectively. PRP is also commonly done for tendinopathy or partial tendon tears of all the above-mentioned tendons. For arthritis we more commonly do stem cell injections in these large joints and PRP in the medium/small joints. However, we sometimes do a booster PRP into the large joints 8-12 weeks after doing stem cell injections.
STEM CELLS also not covered by sureties. They are commonly done for moderate or moderate to severe osteoarthritis of these 3 larger joints. If you are bone on bone, it is probably too late. We may also consider stem cell injections into the subchondral area of the bone if edema is present. Stem cell injections are also considered for complete tendon tears.