HomeHealth articlescorticosteroidsWhat Are the Implications of Corticosteroid Injections in Joints and Soft Tissues?

Corticosteroid Injections in Joint and Soft Tissue Problems

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In inflammatory conditions affecting the joints and soft tissues, corticosteroid injections have helped alleviate symptoms. Read this article to know more.

Written by

Dr. Kayathri P.

Medically reviewed by

Dr. Mohamad Ali Rida

Published At February 3, 2023
Reviewed AtJuly 7, 2023

What Are Corticosteroid Injections?

Corticosteroid injections are administered to the joints and soft tissues in inflammatory conditions. Inflammation is a natural process in healing and is characterized by redness, heat, and swelling in the affected area. Corticosteroid injection is given in cases where the medications do not work or other conventional therapies like physiotherapy have failed to improve symptoms. They are used to relieve swelling and pain that is caused due to swelling in the soft tissues and joints. It is also used in muscles and tendons to alleviate the swelling. These injections are given along with local anesthetics to relieve the patients of pain. It acts quickly on the injected site and provides symptomatic relief.

Why Is It Necessary?

Inflammation is the body’s first response to an injury. Inflammation, in turn, causes pain and swelling in the affected area. Corticosteroid is a type of steroid that will help reduce inflammation drastically. The inflammation is a natural process, but it reduces the blood supply to that area and delays the healing process. Hence, controlling the inflammation is a crucial step in minimizing discomfort. Corticosteroid acts by reducing inflammation and improving the blood supply to that area by expanding the blood vessels supplying that area. They also inhibit the activity of enzymes that cause tissue damage.

How Is It Done?

The affected area is cleansed and sterilized by applying an antiseptic solution. Along with local anesthesia, the corticosteroid is injected through a needle, and then plaster is placed over the injected site to keep it clean and prevent infections. Specific trigger points are identified for muscle injections, and injection is given at that site. Patients have reported significant pain relief for up to six months with one corticosteroid shot. After a corticosteroid shot, patients are advised to reduce activity in the injured area.

It is given in the following joints:

  • Shoulder: In the shoulder, it is given in the subacromial space, which is located above the ball and socket joint of the shoulder, for treating shoulder impingement syndrome and rotator cuff tendinitis. Shoulder impingement syndrome and rotator cuff tendinitis are caused due to repetitive trauma and irritation to the tendons of the shoulder, leading to inflammation.

  • Knee: It is given under the patella (knee cap) for treating knee pain and arthritis.

  • Hand and Wrist: It is given in the palm for conditions like carpal tunnel syndrome. Carpal tunnel syndrome occurs due to pressure and overuse of the hand and arm, leading to numbness and tingling sensation in the hands.

  • Elbow: For lateral epicondylitis, injection is given by keeping the arm downwards and given in the lateral epicondyle, which is located as the bony bumps in the wrist away from the body. Lateral epicondylitis is a condition in which a tendon tear occurs in the lateral epicondyle.

How Many Shots Can Be Taken?

Corticosteroids tend to inhibit the actions of the immune system. For this purpose, only three to four injections are allowed per year in the targeted site, and only six shots are allowed in a year for the entire body.

What Are the Possible Side Effects?

  1. The injected area might become indented and discolored.

  2. Post-menopausal bleeding occurs after steroid injection in women that have attained menopause.

  3. Some anaphylactic reactions (life-threatening allergic reactions) can occur when the body does not accept the drug. Difficulty swallowing, itchy skin, flushing of the face and neck, difficulty breathing, and nausea or vomiting can occur.

  4. Tendon may weaken or ruptures.

  5. Thinning of skin or bone around the injected site.

  6. Nerve damage when the injection is given at an inappropriate site.

What Are the Indications?

Cortisone injections are used for a wide variety of inflammatory conditions of the joints and soft tissues:

  1. Osteoarthritis - It is a degenerative joint disease that affects the joints causing stiffness and pain. It occurs when the cartilage (softer than bone and protects joints like a cushion) near the bone is traumatized due to repetitive wear and tear.

  2. Rheumatoid Arthritis - It is an autoimmune disorder that attacks the immune system of the individual, causing inflammation of almost all joints.

  3. Psoriatic Arthritis - It is a type of arthritis that affects psoriasis-affected patients.

  4. Reactive Arthritis - It is a type of inflammation in which infection in some other part of the body can trigger inflammation of the joints.

  5. Trigger Points - Due to overuse of the muscles of a certain body part, trigger points are formed that are very sensitive even to touch.

  6. Gout - It is also a type of arthritis in which there are sudden attacks of inflammation along with pain and swelling in the joints.

  7. Bursitis - Inflammation of the bursae (fluid-filled sacs that act as cushions) of the joints can be very painful and often accompanied by swelling.

  8. Back Pain - Back pain that is caused due to spinal problems and muscular abnormalities.

  9. Tendinitis or Tendonitis - Tendinitis and tendonitis are used interchangeably and refer to the inflammation of tendons. Tendons are the connective tissue present between muscles and bones.

  10. Synovitis - Inside the joint, there is a membrane called synovium, and this is inflamed in arthritis or in athletes who overuse the joints. This is called synovitis.

What Are the Contraindications?

  • If there is any dental appointment within a week, then corticosteroids are delayed until the appointment.

  • In case of allergies to local anesthetics and corticosteroids, then having a shot of corticosteroids is contraindicated.

  • Patients with diabetes may need screening by the physician for a few days after a corticosteroid shot, as it spikes the blood sugar level.

  • Suppose there are any infections or infectious diseases like bacteremia or septic arthritis. Bacteremia is a condition in which the bacteria are dislodged into the bloodstream, which may result from dental or medical procedures. Septic arthritis occurs when the infection spreads to the joints and causes pain; then, it is contraindicated.

  • In cases of fractures that occurred recently and are painful.

  • In patients who have undergone joint replacement and have a prosthesis (a replacement of the joint made up of ceramic, metal, or plastic).

  • Achilles or patellar tendinopathies: The Achilles tendon is the tendon that connects the calf muscles (muscles of the back) to the heel. Patella is the tendon that connects the patella (kneecap) to the tibia (shin bone). If these tendons are injured or over-exerted, then tendinopathies can occur.

  • Patients who are undergoing anticoagulation therapy: Patients with bleeding disorders will have Warfarin or Heparin to reduce blood coagulation (clotting).

Conclusion:

There are both pros and cons to having a corticosteroid injection. It should be done only on the basis of advice from a physician. Results have been very effective, and many patients have become pain-free, and there is a reduction of swelling and inflammation after having a shot. Effects can last longer, for up to two to six months. As low as the dosage is, so is the safety. Taking too many shots in a year is not advisable as it lowers immunity. Too many injections can damage the tissue. However, for patients who have chronic pain, cortisone injections are an ideal choice for temporary relief as they can lessen the pain and swelling.

Dr. Mohamad Ali Rida
Dr. Mohamad Ali Rida

Rheumatology

Tags:

corticosteroidsjoint pain
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