• Injectable hyaluronic acid is available from multiple companies and marketed under different names including Hyalgan, Orthovisc, Supartz and Synvisc.

• Hyaluronic acid injections are currently approved for osteoarthritis of the knees, and are done in a series of three to five injections depending on the brand used.

• When treatment is considered, a doctor must take a patient's medical history and medication side effects into consideration.

• Individuals allergic to eggs and/or feathers cannot have these injections.

• Hyaluronic acid injections are being studied in other joints including the hips and shoulders.

• A physical medicine and rehabilitation physician (physiatrist) who is expert in non-surgical management of knee osteoarthritis can evaluate you.

• Check with your local physiatrist on the latest treatments available.

• Knee osteoarthritis should be managed with a comprehensive program including:
  • Oral and injectible medications as needed.
  • Regular low-impact exercise, with stretching and strengthening exercises of the lower limbs.
  • Weight reduction in overweight individuals.

Studies show:

• Tumor Necrosis Factor alpha (TNFa) is one of the chemicals in the body that has been targeted to help patients with inflammatory conditions like rheumatoid arthritis, Crohn's disease and psoriasis.

• TNFa plays a role in sciatica or radiculopathy caused by nerve root irritation from herniated discs in the spine.

• A recent study showed that anti TNFa, Infliximab, is a promising treatment option for sciatica.

• The study was a good start, but it was very limited and did not compare the results from Infliximab to other customary medical treatments.

• Symptoms from disc herniation typically resolve over time.

• A patient's medical history and medication side effects must be considered before treatment is considered.

• Anti-TNFa is an intravenous treatment.

• Further studies on anti-TNFa need to be done to address its short and long-term risks and benefits.

• Anti-TNFa is not routinely used for the treatment of radiculopathy.

• A physical medicine and rehabilitation physician (physiatrist) who is an expert in non-surgical management of herniated discs, nerve root injury and sciatica can evaluate you.

• Check with your local physiatrist on the latest treatments available.

• Activities as tolerated with at most a few days of bed rest.
• Diagnostic testing when indicated.
• Pain medication and injections for inflammation, muscle spasms and nerve irritation.
• Referral to a physical therapist or other specialists as needed to restore functional ability as soon as possible.