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Musculoskeletal Injections

Musculoskeletal injections are treatments used to help diagnose the source of pain, reduce inflammation, relieve symptoms, or support healing in joints and soft tissues. Different types of injections work in different ways: some calm inflammation and pain (such as corticosteroids and NSAIDs), some provide short-term numbing to identify the source of pain (local anesthetics), some improve joint lubrication (hyaluronic acid), and others aim to support healing using the body’s own blood or cells (such as PRP, prolotherapy, or biologic injections). These injections are commonly placed into joints, bursae, around tendons or ligaments, or into muscles, depending on the condition being treated. Injections are performed after sterilizing the skin, often with the aid of ultrasound or fluoroscopy to ensure the injection is placed into the desired anatomic location. They are often used to treat arthritis, bursitis, tendonitis, ligament injuries, muscle spasm, or when pain does not improve with rest and physical therapy. The main advantages of musculoskeletal injections are targeted treatment, potential pain relief, and help guiding rehabilitation or diagnosis. The disadvantages are that relief may be temporary, results can vary, some injections are costly or not well supported by strong evidence, and most do not fix the underlying cause on their own. Common musculoskeletal injections include:

Corticosteroid Injections (ex. Methylprednisolone, Betamethasone, Dexamethasone)

Corticosteroid injections (cortisone shots) are medications used to reduce inflammation and relieve pain in muscles, joints, and soft tissues. They work by calming the body’s inflammatory response, which can decrease swelling and make movement more comfortable. These injections are commonly given into joints (such as the hip, knee, or shoulder), bursae (small fluid-filled sacs that reduce friction), or around tendons and nerves. They are often used to treat conditions like arthritis, bursitis, tendonitis, and other painful inflammatory problems, and they can also help confirm the source of pain. The main advantages are that they can provide fairly quick pain relief and allow people to return to daily activities or physical therapy. However, the relief is usually temporary, repeated injections can weaken nearby tissues, and they do not fix the underlying cause of the problem. For more information on corticosteroid injections click on the link.

Purpose of Corticosteroid Injections

  • Reduce inflammation in joints, bursae, or around tendons
  • Decrease pain and swelling to improve function
  • Allow patients to better participate in rehabilitation or physical therapy
  • Serve as a diagnostic tool (pain relief suggests the injected structure is the pain source)

Advantages of Corticosteroid Injections

  • Rapid pain relief (often within days)
  • Can provide significant short- to medium-term symptom improvement
  • Localized treatment with minimal whole-body exposure compared to oral steroids
  • May delay or avoid surgery in some patients
  • Can help confirm the source of pain when diagnosis is uncertain

Disadvantages / Risks of Corticosteroid Injections

  • Pain relief is often temporary (weeks to months)
  • Repeated injections may weaken tendons or cartilage
  • Short-term flare-up of symptoms after the injection can occur (uncommon)
  • Risk of infection (rare but serious)
  • Possible skin thinning or depigmentation at injection site
  • Temporary blood sugar elevation, especially in patients with diabetes
  • Does not address underlying biomechanical or structural causes

Common Uses of Corticosteroid Injections

Local Anesthetics (Lidocaine, Bupivacaine, Ropivacaine)

Local anesthetic injections are medications used to temporarily block pain by stopping nerves from sending pain signals to the brain. They work quickly and can numb an area for minutes to hours, depending on the medication used. These injections are commonly placed into joints, around nerves, into bursae, or into painful soft tissues such as muscles and tendon sheaths. They are often used to help diagnose the source of pain, provide short-term pain relief, or make procedures and physical examinations more comfortable. The main advantages of local anesthetic injections are fast pain relief and helpful diagnostic information with little long-term effect on the body. The disadvantages are that the pain relief is short-lived, they do not reduce inflammation or treat the underlying problem, and repeated use alone is not a long-term solution.

Purpose of Local Anesthetics

  • Diagnostic (identify pain source)
  • Short-term pain relief
  • Often combined with corticosteroids

Advantages of Local Anesthetics

  • Immediate pain relief
  • Helps confirm the pain generator
  • Low cost and widely available

Disadvantages of Local Anesthetics

  • Very short duration (hours)
  • No long-term healing effect
  • Repeated intra-articular use may be toxic to cartilage

Common uses of Local Anesthetics

  • Diagnostic joint or nerve blocks
  • Trigger point injections
  • Facet and peripheral nerve blocks

Hyaluronic Acid (Viscosupplementation)

Hyaluronic acid injections, also called viscosupplementation, are treatments used to improve joint lubrication and reduce pain, most often in people with arthritis. Hyaluronic acid is a natural substance found in healthy joint fluid, where it helps cushion the joint and allows smooth movement. When injected into a joint—most commonly the knee, and less often the hip, shoulder, or ankle—it can help restore some of the joint’s shock-absorbing and lubricating function. These injections are usually used for osteoarthritis when symptoms continue despite exercise, physical therapy, and other non-surgical treatments. The main advantages are that they may reduce pain and stiffness for several months and do not weaken cartilage or tendons. The disadvantages are that pain relief is not immediate, results can vary between patients, the benefit may be modest, and the injections can be costly and are not helpful for everyone.

Purpose of Hyaluronic Acid

  • Improve joint lubrication and shock absorption

Advantages of Hyaluronic Acid

  • Minimal systemic side effects
  • May provide modest relief in knee osteoarthritis
  • Safe for patients who cannot receive steroids

Disadvantages of Hyaluronic Acid

  • Mixed evidence for effectiveness
  • Expensive; often not covered by insurance
  • Slow onset of benefit

Common uses of Hyaluronic Acid

  • Knee osteoarthritis (most common)
  • Occasionally hip or shoulder (off-label)

Platelet-Rich Plasma (PRP)

Platelet-rich plasma (PRP) injections use a small sample of a person’s own blood to help support healing in injured or painful tissues. The blood is processed to concentrate the platelets, which contain growth factors that may help reduce pain and support tissue repair. PRP is most commonly injected into tendons, joints, ligaments, or muscles, such as in cases of chronic tendon pain, mild to moderate arthritis, or certain sports-related injuries. These injections are often used when symptoms have not improved with rest, physical therapy, or other standard treatments. The main advantages are that PRP uses the patient’s own blood and may provide longer-lasting improvement than simple pain-relief injections. The disadvantages are that results can vary, pain relief is not immediate, treatment can be expensive, and strong scientific evidence does not yet support its use for all conditions.

Purpose of PRP

  • Deliver growth factors to promote tissue healing

Advantages of PRP

  • Uses patient’s own blood (autologous)
  • May help tendinopathy and mild arthritis
  • No steroid-related tissue damage

Disadvantages of PRP

  • Variable preparation methods and results
  • Costly and often not covered by insurance
  • Slower symptom relief than steroids

Common uses of PRP

  • Chronic tendinopathy (tennis elbow, Achilles)
  • Mild knee osteoarthritis
  • Partial ligament injuries

Prolotherapy (Dextrose Solution)

Prolotherapy is an injection treatment that uses a dextrose (sugar) solution to help stimulate the body’s natural healing response. The solution is injected into painful or weakened tissues, where it causes mild irritation that may encourage tissue repair and strengthen injured areas over time. Prolotherapy is most commonly used around ligaments, tendons, and sometimes joints, often for chronic pain related to ligament laxity, tendon injuries, or certain types of joint pain. It is usually considered when symptoms persist despite exercise, physical therapy, and other standard treatments. The main advantages are that it uses a simple solution, does not rely on steroids or medications, and may help improve tissue strength over time. The disadvantages are that pain relief is gradual, multiple injections are often needed, and scientific evidence supporting its effectiveness is mixed depending on the condition being treated.

Purpose of Prolotherapy

  • Stimulate healing through controlled inflammation

Advantages of Prolotherapy

  • Inexpensive
  • Generally safe when properly performed
  • May improve ligament or tendon pain

Disadvantages of Prolotherapy

  • Limited high-quality evidence
  • Requires multiple injections
  • Post-injection pain common

Common uses of Prolotherapy

  • Chronic ligament pain
  • Some cases of osteoarthritis
  • Sacroiliac or spinal ligament pain

Biologic / Cell-Based Injections (Bone marrow aspirate concentrate – BMAC; stem-cell–based products)

Biologic or cell-based injections, such as bone marrow aspirate concentrate (BMAC) and stem cell–based products, are treatments that aim to support the body’s natural healing process using cells taken from the patient or a donor source. These injections contain cells and growth factors that may help reduce inflammation and support tissue repair. They are most commonly injected into joints, tendons, or ligaments, often for conditions like arthritis, cartilage damage, or chronic tendonitis that have not improved with standard treatments. The main advantages are that these treatments are designed to support healing rather than just relieve pain and may provide longer-lasting improvement for some patients. The disadvantages are that results can vary widely, treatments can be expensive, and strong scientific evidence is still limited for many uses, so they are not considered standard care for most musculoskeletal conditions.

Purpose

  • Attempt tissue regeneration or repair

Advantages

  • Theoretical regenerative potential
  • Autologous options reduce immune risk

Disadvantages

  • Very limited high-quality evidence
  • Expensive and not insurance-covered
  • Regulatory and ethical concerns
  • Results are unpredictable

Common uses

Botulinum Toxin (Botox®)

Botulinum toxin (Botox®) injections are treatments that reduce muscle overactivity by blocking the nerve signals that cause muscles to contract. When injected into specific muscles, Botox® causes temporary muscle relaxation, which can decrease pain, stiffness, or abnormal muscle pulling. In musculoskeletal care, it is most commonly injected into muscles, and sometimes around nerves, to treat muscle spasms, abnormal muscle tone, chronic pain conditions, or movement disorders. The main advantages are that it can provide targeted relief for several months and does not affect the entire body. The disadvantages are that the effects are temporary, repeated injections are needed, nearby muscle weakness can occur, and it does not treat the underlying cause of joint or tendon problems.

Purpose of Botox Injections

  • Reduce muscle overactivity or spasm

Advantages of Botox Injections

  • Effective for focal muscle spasticity
  • Long-lasting effect (3–4 months)

Disadvantages of Botox Injections

  • Causes temporary muscle weakness
  • Limited role in most orthopedic pain conditions
  • Expensive

Common uses of Botox Injections

  • Spasticity
  • Chronic muscle-based pain syndromes
  • Certain headache or neck pain disorders

Saline or Contrast Agents

Saline or contrast agent injections are fluids used mainly to help with diagnosis rather than long-term pain treatment. Saline is a simple saltwater solution, while contrast agents are special fluids that show up on imaging tests like X-rays, CT scans, or MRI. These injections are commonly placed into joints, around nerves, or into specific spaces to help doctors see structures more clearly or confirm where pain is coming from. They are often used during imaging studies, guided injections, or diagnostic procedures to check joint anatomy, look for tears or damage, or confirm the correct injection location. The main advantages are that they are generally safe, do not damage tissues, and can provide valuable diagnostic information. The disadvantages are that they are not intended to provide lasting pain relief and are not a treatment for the underlying problem.

Purpose

  • Diagnostic rather than therapeutic

Advantages

  • Helps confirm joint or soft-tissue pathology
  • Used in imaging-guided procedures

Disadvantages

  • No therapeutic benefit
  • Temporary discomfort

Common uses

  • MR arthrograms
  • Diagnostic joint distension

Non-Steroidal Anti-Inflammatory Drug (NSAID) Injections (ex. Ketorolac)

Non-steroidal anti-inflammatory drug (NSAID) injections, such as ketorolac, are used to reduce pain and inflammation without using steroids. They work by blocking chemicals in the body that cause inflammation and pain. These injections are commonly given into joints, around inflamed soft tissues, or sometimes into muscle, often for conditions like arthritis flare-ups, bursitis, or short-term musculoskeletal pain. They are usually used when oral NSAIDs are not effective or cannot be tolerated. The main advantages are that they can provide fairly quick pain relief, do not weaken tendons or cartilage like steroids may, and avoid some side effects of oral medications. The disadvantages are that pain relief is usually short-term, they do not promote healing, and they can still carry risks such as stomach, kidney, or bleeding problems, especially with repeated use.

Purpose of NSAID Injections

  • Short-term anti-inflammatory pain relief

Advantages of NSAID Injections

  • Avoids steroid side effects
  • Useful for acute pain flares

Disadvantages of NSAID Injections

  • Short duration
  • Systemic NSAID risks still apply
  • Less effective than steroids for chronic inflammation

Common uses of NSAID Injections

  • Acute bursitis or joint pain
  • Patients who cannot receive steroids

Comparison of Musculoskeletal Injections

Table Comparing Musculoskeletal Injections

Edited by Stephen Pinney MD, February 2nd 2026

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