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Did you know many common musculoskeletal conditions can be improved using corticosteroid injections?

What are corticosteroid injections?

  • Corticosteroids (steroids) are medicines that can be used to treat inflammation. When injected into or around a painful area they can reduce the inflammation in the area; relieving pain, reducing tissue swelling, and improving function and mobility. Depending on the condition that is treated, steroid injections can provide pain relief for several weeks to up to many months.

What conditions can be treated using corticosteroid injections?

  • Arthritis – Arthritis involves pain, stiffness, inflammation and damage to joint cartilage {the tough, smooth tissue that covers the ends of the bones, enabling them to glide against one another) and the surrounding structures. This damage can lead to joint weakness, instability and visible deformities that, depending on the location of joint involvement, can interfere with the most basic daily functions.
  • Bursitis – Bursas are small, fluid-filled sacs that cushion and lubricate points between our bones, tendons, and muscles near our joints. The bursae are lined with synovial cells, which produce a lubricant that reduces friction. This cushioning and lubrication allows our joints to move easily. When a person has bursitis, inflammation of the bursa, movement or pressure is painful.
  • Shoulders, elbows, hips, knees
  • Carpal tunnel syndrome – Carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes pressed or squeezed at the wrist. The median nerve controls sensations to the palm side of the thumb and fingers (although not the little finger), as well as impulses to some small muscles in the hand that allow the fingers and thumb to move. The carpal tunnel – a narrow, rigid passageway of ligament and bones at the base of the hand – houses the median nerve and tendons. Sometimes, thickening from irritated tendons or other swelling narrows the tunnel and causes the median nerve to be compressed. The result may be pain, weakness, or numbness in the hand and wrist, radiating up the arm.
  • Rotator Cuff Injury – Rotator cuff tendonitis is caused by irritation and inflammation of the tendons of the rotator cuff muscles. It tends to have an acute (sudden) onset. There is often a specific preceding injury. It can happen because of recent overuse of the shoulder. For example, it can occur in athletes, particularly those who participate in throwing sports. In non-athletes, there may be a history of recent heavy lifting or activities involving repetitive movements of the shoulder. In some cases the rotator cuff tendons can become calcified. This is when calcium is deposited in the tendons, due to long-standing inflammation. This is called calcific tendonitis.Rotator cuff impingement syndrome is caused when the rotator cuff tendon gets trapped in the subacromial space. The tendon is repeatedly scraped against the shoulder blade, which can eventually lead to fraying of the tendon. This can weaken the tendon, which increases the risk for tear. Impingement syndrome can happen because of long-standing wear and tear. It can also happen due to problems with the bone of the acromion. These can include arthritis and bony spurs {protrusions)Rotator cuff tears usually occur in the rotator cuff tendon rather than in the muscles themselves. In younger people, a rotator cuff tear is often the result of trauma {injury) due to a fall or an accident. In older people, it is often caused by rotator cuff impingement syndrome {see above). Rotator cuff tears can be minor/partial or full/complete depending on the degree of damage to the tendon.
  • Tendonitis – Tendons are the thick bands of tissue that connect muscles to bones. Repeated motion and stress to a tendon can cause it to become inflamed – known as tendonitis- causing impairment of the normal smooth gliding motion of your tendon and movement becomes painful.
  • Rotator cuff injuries, tennis elbow, golfer’s elbow
  • Trigger finger or trigger thumb – Trigger finger is a painful condition that causes the finger or thumb to catch or lock when bent. The tendons in the finger or thumb can become inflamed, causing impairment of the normal smooth gliding motion through the tendon sheath. When bending the finger or thumb the inflamed tendon is pulled through a narrowed tendon sheath, making it “snap” or “pop”.

Is the injection painful?

  • The injection can be uncomfortable; therefore the injection site is prepared with a topical local anesthetic to numb the skin before the injection. A local anesthetic medication, Lidocaine 1% and/or Marcaine 0.5%, is typically added to the corticosteroid injection. This anesthetic can relieve the pain immediately, confirming the injection has hit the right spot. After several hours, the anesthetic will wear off, and you may feel some pain or discomfort until the anti-inflammatory effect of the steroid kicks in, which can be up to two days. Putting ice on the area and/or taking pain medicine may help reduce the discomfort.

Do I need to restrict my activities after the injection?

  • You should rest the affected area for 24 hours and avoid strenuous activities for at least 2 days.

Risks and side effects

  • One of the most common side effects is pain and inflammation of the tissues surrounding the injection site. This is known as post-injection flare, or steroid flare, and may last for several days.
  • People with dark skin occasionally report skin discoloration around the injection site.
  • There is a risk of nerve damage associated with steroid injections
  • There is a small risk of infection associated with these injections. Joint infections are especially serious, and can result in permanent damage to the joint. Call the office immediately if:
    • You experince pain for more than 48 hrs after injection.
    • Pain develops more than 2 days after injection.
    • The area becomes red, hot, or swollen
    • You develop a fever following the injection
  • Corticosteroid injections may weaken tendons, sometimes causing tendons to rupture. Repeated injections of steroids may also damage joint cartilage and contribute to thinning of nearby bone (local osteoporosis). For these reasons, there are limits to how many times and how frequently corticosteroid injections can be used in the same area.

Long-term problems associated with corticosteroid medicines

  • People who take steroid medicines orally for prolonged periods are at risk of several side effects, including weight gain, high blood pressure, and osteoporosis. There is only a very small risk of these problems developing following injections of corticosteroid, because, unlike oral steroids, only very small amounts of the medicine enter the bloodstream.

References

MayoClinic.com. (2012). Prednisone and other corticosteroids. Retrieved from http://www.mayoclinic.com/health/steroids/HQ01431

MayoClinic.com (2013). Cortisone shots. Retrieved from
http://www.mayoclinic.com/heaIth/cortisone-shots/MY00268

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