When coming to the orthopedist/sports medicine doctor, many patients often need and want injections. Knowing what is coming can help relieve a lot of the procedural anxiety, and make the process less painful and an overall easier experience.
In general it comes down to localizing, sterilizing, anesthetizing, the injection, and after care.
Localizing can be done many ways, including landmark based or ultrasound. Landmark based is done with the physician localizing the area needed based on an in depth knowledge of human anatomy and experience. Ultrasound localization utilizes an ultrasound beam to create a real time image of the affected region to find the ideal injection location. This is best for greatest accuracy, particularly in smaller joints or deeper joints or around nerves. After localizing where the needle will be introduced, a mark will be made, usually an indent with a needle or pen cap or with a fingernail.
After localization and the mark has been made, the area will be sterilized. This can be done through a number of different methods including alcohol, chlorhexidine, iodine, or a mixture. Once the area has been sterilized, in general, it is not to be touched again unless by a sterile instrument to not introduce any bacteria to the area
Numbing the area of the injection is usually done with a cold spray made of ethyl chloride, or using a very small needle with a quick acting numbing medicine such as lidocaine
After the area has been numbed, either with the cold spray or injection (or both) the final needle is introduced to the affected area. At this point, it is usually no more than a pressure sensation, as the muscles inside the body don’t have the sensation to feel cutting/stabbing, only pressure. After the injection some pressure can be applied to the area to stop any minor bleeding that may occur, and then a bandage is placed over the area
The bandage can be removed that night and the area cleaned as usual. In general, a few days of relative rest is needed after the injection to allow the tissues to heal from the needle poke and to allow the medicine to begin to work.
Dr Natan Bastoky is a Dual Board-Certified Non-Operative Sports Medicine Physician in Fort Lauderdale, FL. To learn more about Dr Bastoky or to schedule a consultation, click here.