The Evidence-Based Medicine for Injection Therapy

Injection therapy is one of the most widely used modalities for treating musculoskeletal disorders. This treatment modality is defined as a method whereby therapeutical agents are delivered to the selected location with the use of a syringe and hypodermic needle. A clear distinction has to be made between intra-articular and extra-articular injections as each type has its unique aspects. Still, the most frequently used injectable agents are corticosteroids, which have been in clinical practice for more than 70 years. Other injectables such as prolotherapy agents, hyaluronic acid and orthobiologics, are also routinely used. Orthobiologics is an emerging therapeutic modality used in the treatment of musculoskeletal disorders, with platelet-rich plasma and cellular-based products being prominent agents on the market. The increasing number of randomized controlled trials that emerged in recent years show promising results for the use of orthobiologic agents. The approach to injection therapy, as a field of treatment, has been known to be dogmatic and to be flawed by anecdotal evidence. A more evidence-based approach to this field is necessary to oppose some well-established dogmas with the ultimate goal of delivering the best available care to our patients. Musculoskeletal injections are safe and affordable and require fewer logistics than operative treatments, making them an ideal therapy modality for outpatient clinic settings. Physicians should put their efforts into providing adequate care to their patients by giving them the best possible treatment. In this regard, it is constituted of the best possible injection based on updated and critically reviewed literature as well as their clinical expertise.