Corticosteroid injections-the pros and cons by Dr Zeinah Keen



Steroids belong to a class of medications related to cortisone. They are powerful anti-inflammatories and so when injected into soft tissue or joints, it provides a large powerful dose directly into the localised area of inflammation. As cortisol is a naturally occurring chemical in the body, reactions are rare.
The anti-inflammatory effect of the medication ultimately acts as pain relief and the effects can may instantaneous. They can take 48-72 hours to take effect and the outcome can last for months, sometimes years.
They are easy to administer in doctors rooms or in radiology departments under Fluroscopy guidance (epidural and intra-discal injections). Also as the steroid is injected as opposed to being taken orally, gastric upsets can be avoided.
Steroid injections are used in many areas of medicine but commonly used within an orthopaedic setting and can help with conditions such as;

Degenerative disc disease (if diagnosis made by MRI with associated end-plate inflammatory changes)
Plantar fasciitis
Rotator cuff injuries.
Nerve compression
Bone cysts

There is some controversy and fear associated with steroid injections. They should rightfully be used with caution. They are a means to provide pain relief and restore function of activities of daily living. They are not a cure and should be used in conjunction with Osteopathy and limitation of activities. They can even buy more time in the likely event of a joint replacement.
Many of the things patients are usually worried about are consistence with long term steroid use. Such effects can include;

Thinning of the skin
Easily bruised
Weight gain
Puffiness of the face
Elevated blood pressure
Cataract formation

These are the listed side effects of steroid injections and is the case with any injections;

Pain at the injection site

Below are the side effects specifically associated with steroid injections;

Thinning of the joint cartilage
Weakening of the joint ligaments
Weakening of tendons and tendon rupture (more likely in Achilles tendon)
Elevation of inflammation in the area due to cortisone flare (where medication crystallises. This is a rare reaction and usually subsides after a few days of rest and icing the area).

How many doses should someone have?

There are no rules and each case is assessed individually. There is a general consensus that 3 per year is enough. Besides the side effects as listed above, their use can delay normal tissue repair response. Caution should be exercised in young athletes with healthy joints. Other measures should be tried first (ice/heat/osteo/physio/massage) in these cases. In older people with already degenerate joints, this should not be an issue.

If you are thinking about have a steroid injection give Zeinah a call at Village Health Clinic (9452 2292) or drop an email. She will be able to give you some more information and discuss all options. Alternatively you can talk to your doctor.

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