Cortisone Injections (also known as steroid injections) can be effective for temporarily reducing pain and therefore allowing patients to take part in everyday activities. But there are also drawbacks to this treatment. The biggest obstacle is that cortisone injections is tissue damage, particularly multiple shots to the same area are performed. It can accelerate the degeneration of soft tissue, which could make joint degeneration worse in the long term. Cortisone injections can be given in almost any joint to relieve inflammation and the pain associated with it. A joint affected by osteoarthritis has cartilage damage, which can often involve inflammation. Sometimes, this joint inflammation causes pain without causing a lot of visible swelling and redness. In these cases, cortisone Injections are often used in an attempt to relieved pain. If pain is preventing you from doing everyday activities like going to work, exercising, or is affecting your overall health and well-being, a cortisone shot may be worth considering. But it is important to note that this is only a temporary short-term solution. That being said they may be helpful if the pain relief they offer can jump start your efforts to get regular exercise or physical therapy that was too painful prior to your injection. Cortisone injections work in threes in that – it either works, it either works for a very short period and you need another or it does not work at all. If you are fortunate and it does work the pain and inflammation relief of a cortisone injection can last anywhere from 6 weeks to 6 months. However, because of its possible destructive effects, injections need to be spaced 4 to 6 weeks apart and you shouldn't get more than 4 injections per year in the same location. Osteoarthritis requires ongoing pain management that may include everything from injections to activity modifications, exercise, stretching, and even diet. If you do decide to go for a cortisone injection it me should just be one part of a larger treatment plan. While cortisone injections can be very useful in treating joint inflammation and pain, they do have limitations. The main one being that they provide only temporary relief and can be damaging to tissues. Most patients seeking better, long-term relief are advised to participate in a rehabilitation program following to condition their joints, muscles, and other soft tissues. Patients may also be advised to lose weight or make other lifestyle changes, such as changing footwear, which can improve joint biomechanics. It should also be noted that with repeated cortisone injections the patient may notice that the period of pain relief becomes shorter. This is not necessarily because the patient has built up a tolerance to the medication but because the joint is degrading. Again, corrective exercise, weight loss, and changes in day-to-day lifestyle can help slow down or stop joint degradation. Graded activity should be performed. It may take a few days for the benefits of the cortisone medication to take full effect. During this time, patients are usually told to rest and cut back on normal activities. Once the joint pain is relieved, a well-intentioned patient may be tempted to jump right into an exercise routine. However, in order to avoid injuries or possibly making the condition worse, it is advised that a patient resumes to normal activities gradually and add intensity over time.
Repeated Injections Can Affect Soft Tissue
It is very important to note that too many injections over a short period of time can cause damage to the tendons, ligaments, and articular cartilage at the injection site. For this reason:
• Injections should be spaced at least 6 weeks apart, and patients are advised to have 4 or fewer injections in the same place per year.
• Cortisone medication will not be injected directly into a tendon, even if a tendon is suspected to be the root of pain. Because cortisone works locally, an injection near a tendon can still reduce its inflammation. Also, loading tendons like - Achilles and patella tendons are particularly prone to injury post-injection, even if an injection is directed near, rather than in, the tendon. For this reason, cortisone injections for Achilles and patella tendons are not injected.
The initial corticosteroid injection will reduce inflammation and pain in most patients. If the patient's pain is not adequately relieved, a second injection may be performed. If the patient gets limited or no relief from the second injection, then a third injection is unlikely to provide relief and is not recommended.
Side effects or risks People who get cortisone injections to reduce joint inflammation sometimes report side effects.
Potential side effects include:
Pain and swelling (cortisone flare). The injected cortisone medication can crystallize inside the body. The crystals can cause pain and inflammation that is worse than the pain and inflammation caused by the condition being treated. A cortisone flare typically lasts one or two days and can be treated with rest and intermittent cold packs.
Skin discoloration. Some patients with darker skin may notice that the skin around the injection area becomes lighter. The discoloration can be permanent but is not harmful to patients' health.
Increased blood sugar levels. In addition to decreasing inflammation, corticosteroids can raise blood sugar levels. Patients with diabetes should closely monitor blood sugar levels for a day or two following a cortisone injection. (The injection does not deliver cortisone directly to the bloodstream, but it can still influence blood sugar levels in some patients.
Infection. Though rare, it is possible for the injection site to become infected. Patients who suspect an infection or have signs of fever should contact their doctor ASAP.
Allergic reaction. Patients should tell their doctor if they have ever had an allergic reaction following an injection. While uncommon, some patients have allergic reactions to the local anesthetic added to the injection. Allergic reactions to the cortisone itself are rare because cortisone is a synthetic version of cortisol, a steroid naturally found in the body.
Local side effects:
1. post-injection flare/pain
2. subcutaneous atrophy (fat)
3. skin depigmentation
4. bruising
5. soft tissue calcification
6. Steroid arthropathy
7. Tendon damage/rupture
8. delayed soft tissue healing
9. sepsis (Local infection occurs in only 1 in 7000-162000)
10. osteomyelitis can occur after injection
Other side effects can include facial flushing.
Steroid injections can be good for traumatic injury, however if there is blood in the joint (haemarthrosis), the steroid will not be administered. Joint aspiration will however.
Joint aspirations This is the withdrawal of fluid from a swollen painful joint, which in turn can provide very good pain relief. Clinicians do not recommend cortisone injections for patients who have an existing infection, including skin infections and septic arthritis. In addition, cortisone injections may be inappropriate for patients who are taking blood thinners or who have broken bones. Some patients may be concerned about weight gain and water retention from corticosteroid use. However, these side effects are common only for patients who take corticosteroid medications orally for an extended period of time. These side effects to not occur when the cortisone medication is injected into a joint.
Dynamic Osteopaths and Regenerative Medicine rationale for using corticosteroids:
Suppress inflammation
Suppressing inflammatory flares in degenerative conditions
Breaking up the inflammatory damage repair cycle
Protecting cartilage via direct analgesic effect.
Main purpose - to reduce inflammation appropriately to allow for normal functional strengthening and appropriate rehabilitation
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