Injection therapies

What are injection therapies?

Injection therapies are the targeted administration of medications or the body's own preparations into pain-causing structures such as joints, bursa, tendon attachments, nerve root environments or small vertebral joints. The goals are: pain relief, inhibition of inflammation, functional improvement and - in the case of special procedures - diagnostic clarification (e.g. whether a particular joint is actually the pain generator).

• Therapeutic: reduce acute or chronic pain, improve mobility
• Diagnostic: Identify source of pain through test infiltration
• Accompanying: Open window for physiotherapy and training

Anatomy and target structures

For injections to work, they must reach the right structure at the right depth. Therefore, depending on the region, we carry out ultrasound or x-ray support (fluoroscopy) and always with anatomical precision.

• Joints: shoulder, knee, hip, ankle, small joints
• Spine: facet joints (vertebral joints), nerve root surroundings (PRT), sacroiliac joint (SIJ)
• Soft tissues: Bursae, tendon attachments (tendinopathies), fascia
• Muscles: Trigger points for myofascial pain
• Nervous system: Segment or interference field treatment as part of neural therapy

When are injections useful?

Injections are not a panacea, but if chosen correctly, they can efficiently reduce pain and speed up rehabilitation. They come into consideration when basic measures are not effective enough or when a rapid improvement in functionality is required.

• Osteoarthritis-related pain and irritation in large and small joints
• Bursitis (e.g. shoulder, trochanter region)
• Tendinopathies (e.g. tennis elbow, Achilles tendon – according to strict indications)
• Back and neck pain caused by facet joints or SIJ dysfunction
• Radiating leg pain due to nerve root irritation (e.g. intervertebral disc-related radiculopathy)
• Myofascial trigger points
• Diagnostic clarification if the source of the pain is unclear

Conservative base first

We see injections as part of a conservative overall therapy. The basis is education, activity control, physiotherapy, targeted training, if necessary short-term medication, aids and lifestyle factors (e.g. sleep, stress, weight, smoking). Injections can open the window of opportunity for active measures - however, lasting improvement usually comes from exercise, strength and coordination training and favorable stress control.

Procedure at a glance

Which injection makes sense depends on the cause, target structure, comorbidities and your goals. Below you will find frequently used procedures in our practice - each with further detailed pages.

• Periradicular therapy (PRT): precise injection into irritated nerve roots to relieve radicular pain – see details page.
• Facet infiltration: Treatment of small vertebral joints for facet-related back or neck pain – see details page.
• SIJ infiltration: Injections in/around the sacroiliac joint for SIJ pain – see details page.
• Nerve root injections: differentiated approach to the nerve root, diagnostic and therapeutic – see details page.
• Joint infiltrations (shoulder, knee, hip, OSG, etc.): intra-articular or peri-articular – see details page.
• Bursa injections (bursitis): e.g. B. subacromial, trochanteric – see details page.
• Tendinopathy injections: strict indication, tendon-sparing techniques – see details page.
• Trigger point injections: for myofascial pain points – see details page.
• Neural therapy: segmental and interference field-oriented – see details page.
• Botulinum toxin for muscle spasms: for selected spastic or dystonic patterns - see details page.
• Regenerative procedures (e.g. PRP/ACP) and metabolic modulation: for selected tendon and joint problems – see overview.

Active ingredients and preparations

We select substances based on the indication and discuss the benefits, risks and alternatives. If you have previous illnesses (e.g. diabetes, blood clotting disorders), we adapt the procedure individually.

• Local anesthetics (e.g. lidocaine, bupivacaine): rapid, temporary pain relief; also diagnostically relevant.
• Glucocorticoids (“cortisone”), low doses and targeted: can dampen inflammatory activity; Pay attention to the dose and interval when administered repeatedly.
• Hyaluronic acid preparations: viscoelastic support for osteoarthritis; Evidence and benefits vary depending on the joint and individual situation.
• PRP/ACP (autologous blood): potentially regenerative stimuli for selected tendinopathies and degrees of osteoarthritis; still heterogeneous study situation.
• Botulinum toxin: neurogenic muscle relaxation for selected indications (e.g. spastic patterns); not suitable for every form of pain.
• Buffer solutions/saline: for trigger points or as a carrier solution.

Imaging-guided for precision and safety

Precision increases effectiveness and reduces risks. Therefore, depending on the target structure, we use ultrasound (real-time visualization of soft tissue, vessels and nerves) or X-ray fluoroscopy (exact visualization of vertebral joints and nerve root canals).

• Ultrasound: structures near joints and tendons, bursa, trigger points, peripheral nerves
• Fluoroscopy: facets, ISG, periradicular injections
• Safety check: sterile preparation, anatomical landmarks, test aspiration before injection

Course of treatment

Safety, risks and side effects

Serious information is part of it. Serious complications are rare, but every injection has risks. We choose low-risk methods, work in a sterile manner and use imaging-targeted techniques.

• More common, usually mild: temporary pain at the injection site, bruising, brief changes in sensation (with local anesthetics), feeling of warmth/flushing.
• Less common: infection, allergic reaction, bleeding, vascular or nerve irritation.
• Specific to glucocorticoids: temporary increase in blood sugar, skin/fatty tissue changes at the injection site, tendon tissue sensitivity - therefore strict indication and tendon-sparing approach.
• With preparations containing hyaluronic acid: irritant reactions possible.
• Very rare: serious infections, persistent nerve injuries.

Please inform us in advance about any anticoagulants, allergies, infections, pregnancy or relevant previous illnesses. If you experience severe redness, fever, increasing swelling or symptoms of numbness/paralysis after an injection, please see a doctor immediately.

Realistically classify evidence and benefits

The effectiveness of injections varies depending on the indication. They often provide short- to medium-term relief of symptoms, which is what makes consistent active therapy effective. Long-term results depend heavily on concomitant therapies and individual factors.

• Radicular pain: targeted nerve root/PRT injections can reduce pain and avoid or delay surgery in appropriate cases.
• Facet syndrome/SIJ: intra- or periarticular infiltrations can reduce pain and improve function.
• Bursitis and acute irritations: injections containing corticosteroids often provide significant but temporary relief.
• Osteoarthritis: Hyaluronic acid and PRP are used; The benefit varies depending on the joint, stage and study situation.
• Tendinopathies: injective procedures should be used cautiously; Structured training remains central, PRP is discussed in selected cases.

Preparation and aftercare

• Medication: Please state your intake of blood thinners in advance; Discontinue only after consulting a doctor.
• Diabetes: take possible increases in blood sugar into account with corticosteroid injections, close monitoring for 24-72 hours.
• Infections: if there are active infections or wounds, we postpone injections.
• After the injection: 24-48 hours of relative protection, local cooling if necessary, then gradual increase in load.
• Training: incorporate targeted physiotherapy and home exercises promptly.
• Warning signs: increasing pain, redness, fever, symptoms of numbness/paralysis - please seek medical advice.

Common injection procedures – detail pages

• Periradicular therapy (PRT) – go to the details page.
• Facet infiltration – continue to the details page.
• ISG infiltration – continue to the details page.
• Nerve root injections – go to the details page.
• Joint infiltrations (shoulder, knee, hip, OSG) – go to the details page.
• Bursa injections (bursitis) – go to the details page.
• Tendinopathy injections – continue to the details page.
• Trigger point injections – continue to the details page.
• Neural therapy – go to the details page.
• Botulinum toxin for muscle spasms – go to the details page.
• Regenerative Medicine – Overview.
• Cell & Metabolic Regeneration – Overview.
• Traditional Chinese Medicine (TCM) – complementary approach.

Your appointment in Hamburg-Winterhude

Our practice is located at Dorotheenstraße 48, 22301 Hamburg. We take time for diagnostics, information and the joint decision on therapy. You can easily get appointments online via Doctolib or by email.