YOUR HEALTH and corticosteriod injections

Dr. Carole Smith - Clinic Director, BA, DC

Adapted from a review by Dr Shawn Thistle (RRS)

As health care providers who specialize in muscle and joint pain, chiropractors often get patients who ask about receiving musculoskeletal injections to help with their pain. Injections are seemingly offered as a front line treatment in most medical offices, often before conservative therapies are recommended despite consideration of the research in this area.

Injections can be a helpful intervention for the treatment of many muscle and joint problems and are usually either directed into a joint (intra-articular), into structures around a joint (peri-articular), or into painful soft tissues (e.g. muscles, ligaments). Injections can also serve a diagnostic purpose by identifying pain-generating structures (if pain is relieved upon injection, then the right structure has been identified/diagnosed). As well as decreasing pain, injections are also often used to help reduce inflammation, and allow for increased mobility to help exercises be performed.

Patients should experience immediate relief if the injection is made into the right structure. Afterwards, it is not uncommon to experience an occasional increase in pain before the longer lasting pain relief takes effect. Injections are outside of the scope of practice for chiropractors, however we encourage patients to get all the information before deciding on their course of care, and thought we should address this issue since we are asked about it so frequently in our office.

What is injected?

Musculoskeletal injections normally involve a combination of local anesthetics (to provide immediate pain relief) and corticosteroids (to reduce inflammation and provide longer term pain relief).

Potential Adverse Reactions to Injections:

Overall, adverse reactions to the medications that are injected are rare.
Intra-articular injection of corticosteroids DOES NOT increase the progression of osteoarthritis.
Post-injection inflammation may occur, mimicking septic arthritis.
Septic arthritis itself as a result of injection is very rare (0.03% of cases).
There is a risk or hyperglycemia in patients with diabetes.
The risk of hemarthrosis, even in those on anticoagulants such as warfarin, is small (even though this is normally considered a contraindication).
Other complications: skin atrophy (~2.4%); skin depigmentation (~0.8%); post-injection flare (2-10%); vaso-vagal reaction (10-20%); localized erythema/warmth/hypersensitivity (~0.7%); facial flushing (~0.6%); pericapsular calcification (up to ~40%!).

Injections are generally safe and carry only minor risks of side-effects. Of course, these risks and the efficacy of the injection is operator dependent to some degree. When applied correctly, they can be very effective for a number of conditions including:

arthritis – both inflammatory and non-inflammatory (particularly osteoarthritis in the knee)
bursitis – various locations
tenosynovitis – various locations
carpal tunnel syndrome in some cases

Subacromial pain/impingement (shoulder pain) is very common, and injections are often proposed to aid patients in performing their rehabilitation, or for pain relief. A review of the current research suggests that injection provides no additional benefit over NSAIDs (over-the-counter pain medications), so conservative treatment, such as chiropractic care, acupuncture and massage, remains the front line approach to treat shoulder conditions.

For more information or to book your appointment, please contact the clinic.