Friday, August 5, 2011

An Overview Of Risks And Benefits Of Cortisone Injections

By David Greene, MD, CEO


For musculoskeletal issues, cortisone shots may be very helpful. Also called corticosteroid shots, they offer anti-inflammation that may offer excellent pain reduction for arthritis in joints or a soft tissue problem like tennis or golfer's elbow.

Steroid medication contains some of the identical hormones that adrenal glands make in humans. These corticosteroids are important for humans, such as in times of stress providing anti-inflammation.

These soft tissue or joint shots offer temporary pain relief. This effect may last for a few weeks to months, and it could take a few days to start working. Typically numbing medication is included along with the cortisone for immediate relief.

Individuals frequently want to know if the cortisone injections help with fixing the cartilage. Steroid injections do not alter the disease, they are injected to manage patient symptoms and simply reduce pain.

So what are the benefits of a steroid injection?

1. Pain relief - This is the biggest benefit, as the corticosteroid injection doesn't change the course of arthritis. It does reduce pain for a few weeks to months.

2. Low Risk - corticosteroid injections maintain a largely lower risk profil compared to surgery.

3. Low Cost - Also compared with surgery, an injection cost exponentially less.

4. Focused Injection - The cortisone is either injected into either a confined joint space or soft tissue region and the steroid medication stays locally and slowly gets absorbed.

5. Outpatient - The steroid injections are either performed in the doctor's office or as an outpatient. No overnight hospital visits necessary.

6. Can delay the need for surgery - If a person is young and is dealing with horrible osteoarthritis, doing a total knee replacement may only survive 10-20 years. This end up in the need for a revision procedure which often has a less successful result. So the injections may provide a delay for years.

7. Can be placed in multiple joints - If a patient has pain and arthritis in multiple joints, such as the knees, shoulders, and spine, steroid injections may be placed in a few joints (with appropriate care not too many at once).

What are the risks of a steroid injection?

1. Temporary blood sugar elevation - this is most common in diabetics and may raise blood sugars temporarily for 24-48 hours. It would be unusual for this to be an actual clinical problem, but people should be aware of the potential temporary issue, especially diabetics.

2. Cartilage damage - In humans it's not clear if this is clinically relevant. Animal studies have shown cartilage damage with repeated injections. The key is moderation with the number of injections.

3. Adrenal gland suppression - oral steroid medication is the usual culprit for this problem when administered on a repetitive basis, it would be very unusual for a cortisone shot to have this complication.

4. Infection - with sterile technique an infection occurs much less than 1%.

For most people, steroid shots are a great option for pain relief, with moderation being the key.




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