5 Reasons to Get a Corticosteroid Injection

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Corticosteroid Injections: What Are They?

Injection

Although the actual science behind the efficacy of joint and soft tissue injections with corticosteroids is soft--clinical studies fail to support the benefit of this intervention--countless physicians can attest to the pain relief professed by patients who have received steroid injections in their joints.

Corticosteroid (glucocorticoid) shots are used to relieve pain by injection into joints, bursae, tendon sheaths, and soft tissues.  Bursae are are filled with synovial fluid and act as cushions in the joints.  Like brake pads in a car, bursae absorb friction.

Steroids have anti-inflammatory and analgesic effects in the body.  When injected in joints or soft tissue, corticosteroids mitigate inflammation, redness, tenderness and heat.

When performed properly, corticosteroid injections are relatively safe.  Possible complications of injection include allergic reactions, tendon rupture, soft tissue atrophy, hypopigmentation and infection.

Although shorter-acting corticosteroid solutions like dexamethasone don't work that long when injected into joint or soft tissue, in case somebody has a bad reaction like steroid flare, this adverse effect is limited in duration, too.  With steroid flare, the corticosteroid crystallizes in the joint and causes self-limited pain.  Many clinicians mix short-acting dexamethasone solutions with longer-acting betamethasone suspensions to formulate joint injections that exploit the benefits of both short-  and long-acting corticosteroids.

Here are 5 reasons to get a corticosteroid injection.

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Reason 1: Carpal Tunnel Syndrome

Carpal Tunnel Syndrome

Carpal tunnel syndrome causes pain, numbness and tingling in the fingers.  It occurs after the median nerve is impinged on when traveling through the carpal tunnel in the wrist.  Injection of corticosteroids for carpal tunnel can result in months of relief and delay the eventual need for surgery (75 percent of people with carpal tunnel eventually end up having surgery.)

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Reason 2: Osteoarthritis

Steroid injection has been used to treat osteoarthritis in the knee, wrist, hand and hip.  There is little clinical evidence to support the benefit of intra-articular steroid injection into the joints of people with osteoarthritis.  Furthermore, if you do decide to receive joint injections in your joints, it's definitely a good idea have a specialist like an orthopedic surgeon do the procedure.

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Reason 3: Golfer's Elbow (Medial Epicondylitis)

Golfer's elbow

Golfer's elbow or medial epicondylitis is an elbow injury that causes pain over the medial epicondyle (part of the humerus).  Corticosteroid injections may provide short-term relief for this illness.  Platelet-rich plasma injections may help, too.

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Reason 4: Tennis Elbow (Lateral Epicondylitis)

Tennis Elbow

Tennis elbow or lateral epicondylitis is an overuse injury of the tendons of the wrist extensor muscles after they originate from the lateral epicondyle in the elbow.  Like golfer's elbow, the pain of tennis elbow may be relieved over the short-term with the injection of corticosteroids.  Recurrence rates of tennis elbow are high even after corticosteroid injection, and steroid injection probably proffers no long-term benefit.

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Reason 5: Frozen shoulder

Frozen Shoulder

Frozen shoulder or adhesive capsuilitis is a chronic inflammatory condition which affects the shoulder joint and results in shoulder pain, stiffness and limited range of motion.  In addition to corticosteroid injection, other treatment options for frozen shoulder include NSAIDs (think ibuprofen), shoulder manipulation under anesthesia and, as a last resort, surgery.

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Could You Use a Corticosteroid Injection?

Joints

Please remember that corticosteroid shots are meant as additional or adjuvant therapy.  These shots don't take the place of primary or curative treatments (think surgery).   

Furthermore, although some people may benefit from more than one corticosteroid shot for the same condition during the course of a lifetime, those people who fail to respond to corticosteroid injections the first time shouldn't receive another injection.  In other words, if you received a corticosteroid injection for a joint or soft tissue illness and it didn't work, please don't get another steroid injection.

On a final note, joint injections tend to weaken the joint and soft tissue during time; thus, you should avoid getting them too often and never spaced out by less than a few months.  Ultimately for many, corticosteroid injections are a reprieve from pain on the road to surgery.

Selected Sources

Article titled "Corticosteroid Injections for Common Musculoskeletal Conditions: by ZJ Foster and co-authors published in American Family Physician in 2015.

Rosenquist RW, Vrooman BM. Chapter 47. Chronic Pain Management. In: Butterworth JF, IV, Mackey DC, Wasnick JD. eds. Morgan & Mikhail's Clinical Anesthesiology, 5e. New York, NY: McGraw-Hill; 2013. Accessed October 30, 2015.

 

 

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