Joint Injections for Knee, Hip, Shoulder, and Ankle Pain
Joint injections are one of the most common non-surgical treatments for arthritis and chronic joint pain, but they are not all the same. The right injection depends on the joint, the stage of arthritis or injury, your activity level, and what you’re trying to get back to. A treatment that works well for one patient can be the wrong call for another with what looks like the same diagnosis.
Joint injections at this practice are performed by Dr. Jessica Zarndt, a board-certified sports medicine physician, using ultrasound guidance for every procedure.
Is a Joint Injection the Right Next Step?
The knee that hurts on stairs. The hip that wakes you up at night. The shoulder you can’t sleep on. The ankle that never came back right after the last sprain. You’ve tried bracing, ibuprofen, and modifying your activity. It’s not enough anymore.
A joint injection may be the right next step if:
- You have osteoarthritis or chronic joint pain that’s limiting your activity
- You’ve been told you need a joint replacement but you’re not ready, or not a candidate yet
- You’ve had a cortisone shot before but it’s wearing off faster each time
- You want to stay active and avoid surgery for as long as possible
- You’ve had a previous joint surgery and still have pain
- You’re not sure what’s actually causing your joint pain and want a real diagnosis first
Most patients here aren’t looking for a quick fix. They’re looking for the right injection, in the right joint, at the right stage, from someone who can tell them honestly whether it will work.
Why the Type of Injection Matters
Most clinics offer one or two options and recommend them to most patients. The result is a lot of repeat cortisone shots in patients who would have done better with something else, and a lot of patients who never hear about the treatments that might have actually helped them.
There are four main injection types used for joint pain, and each works through a different mechanism. Understanding what they actually do helps explain why one might be a better fit than another.
Hyaluronic acid (HA) injections. Often called gel shots, rooster comb shots, or viscosupplementation. Hyaluronic acid is a substance your joint already produces naturally. It’s part of what gives healthy joint fluid its lubricating and shock-absorbing properties. In arthritic joints, the natural HA breaks down, which contributes to stiffness, pain, and the grinding sensation many patients describe. Supplementing the joint with HA can restore some of that mechanical environment, with relief lasting six to twelve months for many patients. The strongest evidence is for mild-to-moderate knee osteoarthritis, though HA is also used in other joints where appropriate.
PRP injections. Platelet-rich plasma uses your own blood, concentrated to deliver growth factors and modulate inflammation at the tissue level. Where HA addresses the mechanical environment, PRP addresses the biological one. The evidence base for PRP in knee osteoarthritis is substantial, and PRP is increasingly used for hip, shoulder, and ankle joints as well. PRP is often a better fit for younger patients who want to address underlying tissue rather than just manage symptoms.
Combined HA and PRP. Because hyaluronic acid and PRP work through different mechanisms, combining them can produce better outcomes than either alone for certain patients. Peer-reviewed studies have shown longer-lasting pain relief and better function with combination therapy for moderate knee osteoarthritis. The HA provides immediate lubrication and cushioning while the PRP works on the underlying tissue over the following weeks and months. This combination is offered at this practice and is not widely available in Las Vegas.
Cortisone injections. Cortisone reduces inflammation and can provide fast, meaningful short-term relief. The effect is temporary, usually weeks to a few months, and repeated use can accelerate cartilage breakdown and weaken nearby tendons. Cortisone has a place, particularly for short-term relief before a known event or for joints where other options aren’t appropriate. It should not be the default for every patient simply because it’s the fastest and cheapest option.
Why Combination Therapy Is Worth Knowing About
Combined HA and PRP is one of the more meaningful options available for moderate joint arthritis, and most patients have never heard of it.
The reasoning is straightforward. Hyaluronic acid and PRP work on different problems. HA addresses the mechanical environment of the joint by restoring lubrication and shock absorption. PRP addresses the biological environment by delivering growth factors that reduce inflammation and support cartilage health. Treating both at once gives the joint more of what it needs than either treatment can provide alone.
Several peer-reviewed studies have shown that combination therapy produces longer-lasting pain relief and better functional outcomes than either treatment by itself, particularly for moderate knee osteoarthritis. The patients who tend to do best with this approach are those with moderate arthritis who are trying to delay joint replacement, stay active, and get the most out of a single treatment course.
Combination therapy is not the right call for every patient. Some do better with PRP alone, some with HA alone, and some with neither. Figuring out which is part of the consultation.
Joints Treated
Dr. Zarndt performs ultrasound-guided injections in the wrist, elbow, shoulder, knee, ankle, and hip.
Knee
- Knee osteoarthritis
- Meniscal injury pain
- Patellofemoral pain
- Post-surgical pain after meniscectomy or ACL reconstruction
Hip
- Hip osteoarthritis
- Greater trochanteric pain (bursitis)
- Hip labral pain
- Post-surgical hip pain
Shoulder
- Shoulder osteoarthritis
- AC joint arthritis
- Rotator cuff related pain
- Frozen shoulder
- Post-surgical pain after rotator cuff or labral repair
Ankle and foot
- Ankle osteoarthritis
- Chronic pain after repeated sprains
- Subtalar joint pain
- Big toe arthritis
Elbow and wrist
- Elbow osteoarthritis
- Wrist arthritis
- Thumb CMC joint arthritis
If you’re not sure which joint is actually the problem, that’s part of what the first visit is for. Diagnosis comes first.
Why Ultrasound Guidance Matters
A joint injection only works if the medication actually reaches the joint. That sounds obvious, but it’s where many injections fail.
Blind injections, the kind done in a primary care office without imaging, miss the target more often than patients realize. Research has consistently shown that even experienced clinicians miss the joint space on blind injections at significant rates, particularly in joints that are deep, structurally complex, or have been previously operated on. The hip, shoulder, and ankle are the most commonly missed. A missed injection isn’t just a wasted treatment. The medication ends up in surrounding soft tissue, where it doesn’t help and can sometimes cause its own problems.
With live ultrasound guidance, the needle is visible in real time and the medication is placed exactly where it needs to go. Every injection at this practice is performed under ultrasound for that reason. This matters most for joints that are hardest to inject blind, for joints with altered anatomy from previous surgery, and for cash-pay treatments like PRP and HA that need to reach the target to justify the cost.
What Makes This Different
A joint injection is a simple procedure to perform, but a complicated decision to make well. Three things shape the approach at this practice.
More than one option. Most clinics default to cortisone because it’s covered, fast, and easy. This practice offers cortisone, hyaluronic acid, PRP, and combined HA and PRP, and recommends them based on what the joint actually needs rather than what’s easiest to bill.
Combined HA and PRP for moderate joint arthritis. This combination is supported by solid academic evidence and is offered routinely here. It is not widely available elsewhere in Las Vegas.
Diagnosis-first care. A treatment plan starts with the right diagnosis, not the most common one. That means an in-office ultrasound or X-ray during the same visit when needed, reviewing your imaging together, and making sure the joint that hurts is actually the joint causing the problem before deciding what to inject.
How to Know Which Injection Is Right for You
There isn’t a single answer that applies to everyone, and no one should be giving you one over the phone. The right choice depends on factors that come out in the consultation:
- Which joint, and how confident the diagnosis is
- What stage the arthritis or injury is in, based on imaging
- What you’ve already tried and how it worked
- Your age, activity level, and what you’re trying to get back to
- Your timeline (training for an event, scheduled surgery you’re trying to delay, vacation in three weeks)
- Cost and insurance considerations
- Realistic expectations for each option
Sometimes the answer is an injection. Sometimes it’s a different injection than the one you came in asking about. Sometimes the answer is no injection at all, and a different plan entirely. You’ll leave the consultation knowing which and why.
Cost and Insurance
Coverage varies meaningfully by injection type.
Hyaluronic acid (HA) injections. Commonly covered by commercial insurance and Medicare for knee osteoarthritis when conservative treatment has been documented. Coverage for HA in other joints varies because the FDA approval is specific to the knee. Use elsewhere is off-label but well-supported in practice.
PRP injections. Cash pay. Not covered by insurance.
Combined HA and PRP injections. Cash pay. Not covered by insurance.
Cortisone injections. Typically covered by insurance.
Work comp is accepted for related injuries. Call the office and we’ll verify your benefits before scheduling.
Frequently Asked Questions
How long do hyaluronic acid injections last? Most patients get six to twelve months of relief from a course of HA injections in the knee. Some get longer, some get shorter. The series is generally repeatable.
How is PRP different from a gel shot? PRP uses your own blood to deliver growth factors and address the underlying tissue. HA (the gel shot) restores lubrication and cushioning in the joint. They work through different mechanisms, which is also why they can be used together.
Why would I get both HA and PRP instead of just one? For moderate joint arthritis, particularly in the knee, the two treatments address different parts of the problem. Combination therapy has been shown in peer-reviewed studies to produce longer-lasting relief and better function than either alone for the right patient.
Is one injection enough or do I need a series? It depends on the type of injection and the joint. HA is often a series of one to three injections. PRP for joints is often two to three injections in a course. Cortisone is usually a single injection. The plan is built around your specific situation.
How long until I feel a difference? Cortisone works within days. HA generally takes two to four weeks for the full effect. PRP takes four to six weeks or longer, with continued improvement out to three to six months. If you need fast relief before a specific event, that affects which option makes sense.
Can I still get an injection if I’ve already had a joint replacement? Yes, in many cases. Pain after a joint replacement has different causes than pain in an arthritic joint, and the right injection depends on what’s actually driving the pain. Ultrasound guidance is especially important in these cases.
Can I still get an injection if I’ve had multiple cortisone shots in the same joint? Usually yes. The relevant question is whether more cortisone is the right answer, given that the effect has been wearing off faster each time. For many of these patients, a different type of injection is a better fit.
Is the injection painful? Most patients describe pressure rather than pain during the injection. Local anesthetic is used. Soreness for one to three days afterward is normal, particularly with HA and PRP.
How soon can I go back to running, lifting, or playing my sport? Most patients return to light activity within a day or two. Return to full sport-specific activity depends on the injection and the joint. The plan is built around your goals.
Will an injection help me avoid a joint replacement? For some patients, yes, particularly those with mild-to-moderate arthritis who respond well to PRP, HA, or combination therapy. For patients with severe arthritis and significant cartilage loss, injections can buy time but typically don’t change the eventual need for surgery. Imaging and an honest evaluation are part of figuring out which group you’re in.
Why does my primary care doctor just keep giving me cortisone? Cortisone is what most non-specialty offices have available. It works, it’s covered, and it’s easy to administer. The other options (HA, PRP, combination therapy, ultrasound guidance) generally require a sports medicine or orthopedic specialist. That’s not a knock on primary care. It’s just the scope of the visit.
The Right Injection, in the Right Joint, at the Right Time
If you’re tired of repeat cortisone shots that wear off faster each time, or you’ve been told replacement is your only option and you’re not ready, there’s more to consider. A consultation includes imaging review, a real diagnosis, and an honest conversation about which injection (if any) makes sense for where you are right now.