As part of a nonsurgical treatment plan, doctors at NYU Langone may recommend an injection of corticosteroids, platelet-rich plasma, or stem cells to relieve pain and swelling and encourage healing.
If bursitis or tendinitis causes significant pain that is not relieved by over-the-counter NSAIDs, doctors may recommend an injection of corticosteroid medication directly into the area surrounding the bursa, which is a thin, fluid-filled sac that act as a cushion between the tendon and bone, or the tendon, which is a tough cord of tissue that connects muscle to bone. Corticosteroids can quickly reduce inflammation and irritation, alleviating pain.
Doctors administer injections on an outpatient basis. You can expect to return home within hours of the procedure. Depending on the location of the affected bursae or tendons, doctors may use X-ray or ultrasound imaging during the procedure to ensure that the medication is injected into the most effective place.
Repeated corticosteroid injections may risk weakening tendons, particularly those that bear much of a person’s body weight, such as the Achilles tendon in the ankle. Our doctors recommend limiting this treatment to one or two injections separated by four to six months. If pain persists, doctors may recommend surgery to relieve symptoms.
The site of injection may be swollen or tender for one or two days. Your doctor may recommend an over-the-counter pain reliever as well as the application of an ice pack for 15 minutes at a time to relieve pain and reduce swelling.
Doctors may inject a natural substance called platelet-rich plasma (PRP) into the area affected by bursitis or tendinitis to help injured tissue heal more quickly. Platelet-rich plasma is composed of blood cells called platelets that are taken from your own blood. Platelets help tissues heal after an injury by releasing substances called growth factors that stimulate healing.
In this procedure, a doctor takes a small amount of your blood from a vein in your arm and uses a machine called a centrifuge to separate the platelets and growth factors from other blood components. This process takes about 15 minutes. A doctor then injects this platelet-rich liquid, called plasma, directly into the injured bursa or tendon. Our doctors use ultrasound guidance to ensure precision. People often experience pain relief and improved function within two to six weeks.
Stem cells are unique in that they can develop into any type of cell—for example, cells that help repair damaged tissue. When injected into an injured bursa or tendon, stem cells may encourage the damaged tissue to regrow and heal. Injections of stem cells also reduce inflammation. The exact way stems cells work is still being researched, but some people find that an injection of stem cells relieves pain and swelling and may help speed recovery.
Our doctors obtain these stem cells from your body, typically from bone marrow in your pelvic bone, using a syringe. The area is thoroughly numbed before the stem cells are extracted, but the procedure may cause mild discomfort.
After the stem cells are separated from blood and other substances in the bone marrow, they are injected directly into the bursa or tendon. Stem cell therapy does not produce results right away. However, over time the regenerative effect of stem cells may help damaged tissue to heal fully. Most people experience improved function and relief from pain after two to six weeks.
Doctors recommend avoiding anti-inflammatory drugs such as ibuprofen for four to six weeks after treatment while the injury heals. This is because the platelet-rich plasma or stem cell injection stimulates the body’s inflammatory response, an important part of healing. If the site of injection is sore or swollen in the days after treatment, doctors recommend taking over-the-counter acetaminophen and applying an ice pack for 15 minutes at a time three times a day.
You should also avoid strenuous activities using the affected body part for four weeks after the injection to give the injured tissue time to heal. If bursitis or tendinitis affects your foot, ankle, or knee, your doctor may provide you with a special boot to keep your foot and leg immobile. All weight should be kept off of the affected area for two days, and your doctor can provide you with crutches to help you move around without putting weight on the injured area. The boot should be worn for two to three weeks.
Your doctor schedules a follow-appointment after three or four weeks to evaluate the healing process. He or she may recommend an additional platelet-rich plasma or stem cell injection depending on the extent of the injury.
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