YOUR HEALTH and corticosteroid injections

YOUR HEALTH and corticosteroid injections

As health care providers who specialize in muscle and joint pain, chiropractors often have patients ask about receiving musculoskeletal injections to help with their pain. 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. As injections are offered as a front-line treatment in most medical offices, often before conservative therapies are recommended and despite consideration of the research in this area, we wanted to offer some information for our patients who might have questions.

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. They 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 (for example, muscles or 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. As well as decreasing pain, injections are also often used to help reduce inflammation and allow for increased mobility to help exercises be performed.

If the injection is made into the right structure, patients should experience immediate relief. Afterwards, it is not uncommon to experience an occasional increase in pain before the longer lasting pain relief takes effect.

When applied correctly, injections 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

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 over-the-counter pain medications (NSAIDs), so conservative treatment, such as chiropractic care, acupuncture, and massage, remains the front line approach to treat shoulder conditions.

Potential adverse reactions to injections

Injections are generally safe and carry only minor risks of side-effects. Of course, these risks and the efficacy of the injection depends on the operator to some degree. Overall, adverse reactions to the medications that are injected are rare.

• Pericapsular calcification can occur in up to 40% of patients.
• Post-injection inflammation may occur, mimicking septic arthritis. Septic arthritis itself as a result of injection is very rare (0.03% of cases).
• In patients with diabetes, there is a risk of hyperglycemia.
• 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%);

Adapted from a review by Dr. Shawn Thistle (RRS)