Injections

Common Misconceptions About Injections

Injections are safe, powerful tools for treating and healing many shoulder problems. I have performed over one thousand shoulder injections and witnessed how they safely help many patients get well.

Amazingly, patients who have never had injections have many misconceptions about this powerful treatment.

Common Questions About Corticosteroid Injections

Here are some common questions I have been asked by my patients :

What are corticosteroids?     

Cortisone, or my preferred choice of corticosteroid – kenalog, are in the family of drugs called corticosteroids. Corticosteroids are naturally occurring hormones made from cholesterol in the adrenal glands. They directly and indirectly affect the production of important enzymes in the body. In clinical practice, steroid injections are used for their potent anti-inflammatory effects. Corticosteroids are very different from the anabolic steroids used by athletes who have made recent headlines.    

How do corticosteroids work?

Corticosteroids directly heal the inflammation in the area of the injection. Normal cells in response to an injury usually produce inflammatory chemicals. Corticosteroids work on the cells to end the injury response. This stops the production of inflammatory chemicals. Often inflammation is present long after the initial injury, so healing inflammation can be permanent treatment. By healing the inflammatory process, the function of the shoulder will increase because there is less pain with movement. By reducing pain you will be able to exercise and strengthen your shoulder more effectively.

How does a corticosteroid get injected?

Most of the time, they are injected with an anesthetic such as Lidocaine or Marcaine (similar to Novocain used by the dentist). The local anesthetic will have a noticeable effect within ten minutes. The pain should be reduced.

Sometimes local nerves will also become numb temporarily. The steroid then soaks into the tissue; it will start working in the next several days. Occasionally, it can take up to a week for a noticeable effect. The medicine often continues working for up to thirty days.

Are corticosteroid injections painful?

Most patients have a low to moderate level of discomfort from the injection followed by relief from the anesthetic medicines. Most patients are pleasantly surprised.

During a three-month period, patients in my practice were asked to rate their discomfort from the injection on a scale from zero to ten with ten being the highest pain. The average rating by my patients for this injection was two. In other words, most patients find the discomfort to be quite low.

A few patients notice an achy pain the next day or two. This is relieved by icing the shoulder. The medicine can stay active for three to four weeks.

Are corticosteroid injections painful?

Most patients have a low to moderate level of discomfort from the injection followed by relief from the anesthetic medicines. Most patients are pleasantly surprised. During a three-month period, patients in my practice were asked to rate their discomfort from the injection on a scale from zero to ten with ten being the highest pain. The average rating by my patients for this injection was two. In other words, most patients find the discomfort to be quite low. A few patients notice an achy pain the next day or two. This is relieved by icing the shoulder. The medicine can stay active for three to four weeks.

Do corticosteroids weaken bones?

Although oral steroids can lead to bone loss, it does not seem to be an issue with judicious use of injectable corticosteroids.

Do corticosteroids weaken tendons and ligaments?

There is concern for patients who have rheumatoid arthritis, but in general, with judicious use, no current evidence suggests that harm is done to the tendons or ligaments

Is the effect temporary?

The injection does not mask symptoms. And while the medicine itself is only working for up to thirty days, the effect can be long lasting. In fact, often it is curative. This is because often the pain and dysfunction of the shoulder is related to inflammation. So once the inflammation is healed, unless it is initiated again by injury, the problem is treated. It is equivalent to hitting the restart button on your computer.

Are there any risks?

Significant complications from steroid injections are rare (reported less than one in 15,000). More commonly, patients will report soreness from the injection during the first day, but usually it is self-limiting.

Occasionally, the skin will lose its normal pigment or local fat will atrophy. Allergic reactions to medicines are checked prior to the injection. Most people have been to the dentist; therefore, they know if Novocain style medications are safe for them.

In otherwise healthy patients, there is no known risk from the medicine.

Caution for those with diabetes : If you are an insulin-dependent diabetic with good control of your blood sugar, you can have the injection. However, you may have a short-term increase in your blood sugar, so you will need to supplement your diabetes routine. You should contact the doctor who treats your diabetes if there are any questions or problems.

How often can injections be given?

A wide variety of opinions exist regarding the number of injections that are safe to receive. Most of the time, I limit them to three to four a year and no more frequently than every two months.

Can I do regular activities after the injection?

The injection takes less than twenty seconds to perform. Patients usually experience significant relief from pain within five to ten minutes after the injection. You can resume normal activities immediately after the injection the majority of the time.