Archive for May, 2010
Non-operative Treatment of Joint Pain
WHAT IS CORTISONE?
Corticosteroids are a class of steroid medications that closely resemble cortisol, a hormone naturally produced by the adrenal glands. Corticosteroids are used to reduce the inflammation, swelling and pain caused by a variety of diseases including osteoarthritis, bursitis and tendonitis. Examples of corticosteroids include Celestone, Kenalog and methylprednisolone (Depo-Medrol) which can be injected into tissues or joints, as well as others that can be taken orally, applied topically to the skin, or given intravenously for systemic circulation.
IS A CORTISONE INJECTION A TEMPORARY REMEDY?
Corticosteroids relieve pain by reducing inflammation. While the inflammation for which corticosteroids are given can recur, corticosteroid injections can provide months to years of relief when used properly. These injections can also cure diseases (permanently resolve them) when the problem is tissue inflammation localized to a small area, such as bursitis or tendonitis. Injections reduce inflammation caused by mechanical damage, but cannot heal tears or ruptures of muscles, tendons or ligaments.
WHAT ARE CORTISONE INJECTIONS USED FOR?
Local cortisone injections can be used to treat the inflammation of small areas of the body. Examples of conditions for which local cortisone injections are used include:
- Bursitis (inflammation of a bursa)
- Tendonitis (inflammation of a tendon)
- Arthritis (inflammation of a joint and cartilage degeneration)
- Plantar fasciitis
WHAT ARE THE ADVANTAGES OF CORTISONE INJECTIONS?
Corticosteroid injections can relieve localized inflammation of a particular body area more rapidly and powerfully than traditional anti-inflammatory medications given by mouth, such as ibuprofen, aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs). They also can avoid certain side effects that accompany many oral anti-inflammatory medications, notably irritation of the stomach. The injections can also be administered easily in our office.
Cortisone injections administered directly into a knee, shoulder or elbow joint that is immobilized by inflammation, can be beneficial by rapidly reducing inflammation and pain and restoring function. A cortisone joint injection can also decrease inflammation in other diseased joints in the body as the corticosteroids are absorbed from the joint into circulation throughout the body. It is important to note that although potential adverse reactions (described below) can occur, when used properly in low, intermittent doses, cortisone injections present little risk of significant side effects.
WHAT ARE THE DISADVANTAGES AND SIDE EFFECTS OF CORTISONE INJECTIONS?
Short-term complications are possible, but uncommon. They include:
- Local bleeding from broken blood vessels in the skin or muscle
- Soreness at the injection site
- Atrophy at the injection site
- Depigmentation (lightening of the skin) at the injection site
- Aggravation of inflammation in the area injection because of reactions to the corticosteroid medication (post-injection flare)
- Tendon weakening
- Brief facial flushing
- Elevation of blood sugar in people who have Diabetes
- Mild suppression of the immune system in people with active infections
Frequent administration of high doses of cortisone, which is not clinically recommended, is accompanied by more long-term risks. These include, tendon weakening and rarely tendon ruptures when cortisone is injected directly into the tendon, thinning of the skin, easy bruising, weight gain, puffiness of the face, acne, elevation of blood pressure, cataract formation and osteoporosis. Frequent administration of corticosteroids into a joint, which again is not clinically recommended, may have additional side effects including thinning of the joint cartilage, weakening of ligaments of the joint, increased inflammation due to crystallization of a corticosteroid and joint infection.
HOW ARE CORTISONE INJECTIONS GIVEN?
The medical professional administering the injection draws up the corticosteroid into a syringe. A slow-acting numbing, pain-relieving local anesthetic, such as marcaine may be simultaneously drawn into the syringe, and/or a more rapid-acting local anesthetic such as lidocaine may be drawn into a separate syringe to be injected prior to the corticosteroid.
Next, the affected area that will be injected is prepared and cleaned with a local anti-septic. Ethyl chloride spray is used to topically anesthetize this area with rapid cooling and the needle is inserted into the inflamed joint or tissue. The cortisone is then injected into the affected area. The needle is withdrawn and a sterile bandage is applied to the injection site.
If there is excessive fluid within the joint, the physician often will remove it with a separate needle and syringe prior to the injection of cortisone. Removal of this fluid reduces pain and swelling in the joint. The fluid may also be sent to a laboratory for analysis. In addition, this aspiration may aid in a more rapid healing process.
- R.I.C.E. – Rest, apply ice, use compressive bandage, elevate as needed.
- If you are diabetic, regularly check blood sugar, as the cortisone injection may cause an increase in your blood sugar. If your blood sugar level rises, call PCP or other or managing physician.
- Resume regular activities as tolerated within 10-14 days.
- It often takes at least 2 weeks for the injection to take its full effect. The injection may last 6-8 weeks or even longer, and in some cases the pain may never return.
Driver C, Shiel W, Stöppler M. Cortisone Injection (Corticosteroid Injection) of Soft Tissues & Joints. MedicineNet. Last referenced May 2013.