Injectable Corticosteroids

Corticosteroids are potent drugs used to reduce inflammation in the body’s tissues. They are different from anabolic steroids. These are illegally used by some athletes to increase muscle tone.

Corticosteroids can come in several forms: pills, liquids, creams, ointments, medicines sprayed into the nose, and injectable medicines.

Photo of syringe and needle

Corticosteroid injections can treat a variety of skeletal, muscular, and spinal conditions. Some of these injections can be performed by your health care provider during a routine clinic visit; others need a referral to a pain or other specialist.

Here are some of their most common uses:

  • Osteoarthritis. People with osteoarthritis often develop pain and inflammation in their joints. An injection of corticosteroids into the affected joint can give temporary pain relief for several weeks or months. After the treatment, your health care provider may recommend avoiding strenuous activity for at least 24 hours for the best results.
  • Low back pain. Lower back pain from ruptured disks, spinal stenosis, and some other conditions may be treated with injectable corticosteroids to provide some relief. Lumbar radiculopathy is pain in the buttocks, hips, or legs that comes from a pinched nerve in the lower back. This type of pain can often be treated with corticosteroid injections near the pinched nerve. Sometimes other drugs like local anesthetics are given with the corticosteroid.
  • Cervical radiculopathy. This is neck pain that radiates to the shoulder, arm, or hands. It happens when the vertebrae in the spine move closer together or a disc bulges or ruptures, pinching a nerve in the neck. Injecting corticosteroids near the pinched nerve may reduce swelling and relieve pain. This gives the nerve some time to heal.
  • Bursitis and tendonitis. Bursitis is a common condition that happens when the fluid sac that normally cushions spaces between bones, muscles, and skin becomes inflamed and painful. Tendonitis is a common condition in which the tendons around muscles and bones become inflamed. The areas that are commonly affected are the elbow, knee, shoulder, wrist, hand, and hip. Injected corticosteroids can reduce the inflammation. But you must be careful because repeated steroid use can cause the tendon to weaken or even rupture.
  • Carpal tunnel syndrome. This condition happens when a nerve in the wrist becomes compressed or pinched, causing pain, numbness, tingling, and possibly weakness in the hand. Injecting a corticosteroid into the wrist can give immediate, though temporary, relief. An anesthetic like lidocaine may also be given with the steroid.

Cautions about corticosteroids

Corticosteroids can have a number of side effects, including high blood sugar levels. For this reason, people with diabetes are advised to tell their health care providers about their condition before taking any steroid medicines.

Using injectable corticosteroids for a long period of time is not suggested because of additional side effects. These include osteoporosis, cataracts, delayed growth, stomach ulcers, skin atrophy and depigmentation, and high blood pressure. You may experience short-term side effects like local pain or infection at the injection site. Your health care provider will usually limit your total number of corticosteroid injections to 3 to 4 a year.

If you are considering taking corticosteroids to treat a muscular or skeletal condition, be sure to talk with your health care provider about all the benefits and risks.

Osteoporosis: Evaluate Your Risk

What is osteoporosis?

Osteoporosis is a disease that causes rapid thinning of bones. Over time, this weakens the bones and can make them more likely to break. It can affect any bone, but the hip, spine, and wrist are most often involved.

What are the risk factors for osteoporosis?

Women are more likely than men to develop osteoporosis. This happens partly because men have larger, stronger bones. Men and women older than age 50 are at the greatest risk for developing osteoporosis. One in 2 women and 1 in 4 men in this age group will fracture a bone because of osteoporosis. People who are white or Asian are more likely to develop osteoporosis than people who are Hispanic or African-American.

Other risk factors that may increase your chances for developing osteoporosis include:

  • Having small bones
  • Lack of physical activity or exercise
  • Smoking
  • Drinking too much alcohol
  • Have a diet low in calcium and vitamin D
  • Previous fracture, especially after age 50
  • Being postmenopausal
  • Taking certain medications, for example long-term use of corticosteroids
  • Family history of osteoporosis

Many people are unaware they have osteoporosis until they have advanced symptoms. These may include a broken hip or wrist, low back pain, or a hunched back.

How is osteoporosis diagnosed?

If your health care provider thinks that you have osteoporosis, a simple, painless test to measure bone mineral density can confirm it. The test is called a bone density test.

If you’re diagnosed with osteoporosis, a number of medications are available to treat it. Talk to your health care provider about the type of treatment that’s best for you.

Can osteoporosis be prevented?

To help prevent osteoporosis:

  • Talk with your health care provider about screening tests for osteoporosis.
  • Do regular weight-bearing exercise. This means activities that work your legs against gravity. The best exercises are walking, dancing, jogging, stair-climbing, playing racquet sports, and hiking. If you’ve been inactive, be sure to check with your health care provider before beginning any exercise.
  • Talk with your health care provider about your diet and whether or not you need to take a vitamin and mineral supplement important site.
  • Don’t smoke. If you smoke, get help from your health care provider to quit.
  • Don’t drink alcohol in excess.

Stress Fractures

What are stress fractures?

Anatomy of the foot
Click Image to Enlarge

A stress fracture is a very small, fine break in the bone caused by continuous overuse. Stress fractures often occur in the foot after training for basketball, running, and other sports. While stress fractures can occur in many bones that are subjected to repetitive activities, the bones of the legs and feet are at greatest risk. The bones in the midfoot (metatarsals) in runners are especially vulnerable to stress fractures.

What are the symptoms of a foot stress fracture?

A stress fracture may not cause obvious swelling. But symptoms can occur a bit differently in each person. Symptoms may include:

  • Pain in the front of the foot, often after long or intense bouts of exercise
  • Pain that goes away after exercise, then returns when exercise is continued

The symptoms of stress fractures can be like other health conditions. Always see your doctor for a diagnosis.

How is a stress fracture diagnosed?

Diagnosis of a stress fracture usually is confirmed with a complete health history and a physical exam. X-rays often cannot see stress fractures because they are so fine. So a bone scan or an MRI may be done. Once calluses form around the fracture, an X-ray can confirm a stress fracture.

Treatment for a stress fracture

Treatment is aimed at relieving pain and giving the fracture time to heal, usually around 6 to 8 weeks. Specific treatment for a stress fracture will depend on:

  • Your age, overall health, and health history
  • How serious your injury is
  • How well you are able to handle certain medicines, procedures, and therapies
  • How long your injury is expected to last
  • Your opinion or preference

Treatment may include:

  • Rest
  • Protection of the fracture site with reduced weight bearing
  • Cold packs
  • Medicine such as ibuprofen
  • Shock-absorbing shoes to use during exercise
  • Running on soft surfaces, such as grass
  • Physical therapy
  • Switching to a less stressful activity, such as swimming or biking
  • Wearing a brace or cast

Shoulder Dislocation

What is dislocation of the shoulder?

If you have dislocated your shoulder, your upper arm bone (humerus) has moved out of your shoulder joint. This is the most frequently dislocated major joint of your body. Dislocation is often caused by a significant force that separates your shoulder joint’s ball (the top rounded portion of your upper arm bone) from your joint’s socket (glenoid).

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What causes a shoulder dislocation?

Your shoulder can dislocate in several ways, including:

  • Forward and downward dislocation. These are the most common types of dislocations. They usually result from falling on your outstretched hand or on your shoulder itself.
  • Backward dislocation. This type of dislocation may be caused by a direct blow to the front of your shoulder, or the violent twisting of your upper arm.

Your shoulder can be either partially or completely dislocated. Partial dislocation is when the head of your upper arm is partially out of your shoulder socket. Complete dislocation is when the head of your upper arm is completely out of your shoulder socket.

What are the symptoms of a shoulder dislocation?

The following are the most common symptoms of a dislocated shoulder. However, you may experience symptoms differently. Symptoms may include:

  • Pain in your upper arm and shoulder, which is usually worse when you move them
  • Swelling
  • Numbness and weakness
  • Bruising
  • Deformity of your shoulder

The symptoms of a dislocated shoulder may resemble other conditions or medical problems. Always talk with your healthcare provider for a diagnosis.

How is a shoulder dislocation diagnosed?

In addition to a complete medical history and physical exam, diagnostic procedures for a dislocated shoulder usually include an X-ray.

How is a shoulder dislocation treated?

Your healthcare provider discusses with you specific treatment for a shoulder dislocation, based on:

  • Your age, overall health, and medical history
  • Extent of your injury
  • Your tolerance for specific medicines, procedures, or therapies
  • Expectations for the course of your injury
  • Your opinion or preference

Treatment may include:

  • Moving the head of your upper arm bone back into your shoulder joint, usually with an anesthetic
  • Immobilizing your shoulder with a sling after reduction
  • Rehabilitation
  • Surgery, if nonsurgical measures do not restore stability

Can a dislocated shoulder be prevented?

Maintaining muscle strength and flexibility can help prevent shoulder dislocations.  Once your shoulder is dislocated, physical therapy may help prevent you from dislocating it in the future. Through restoring your shoulder’s range of motion and physical strength, your risk for dislocation decreases.

How is a shoulder dislocated managed?

Once your shoulder has been placed back into the socket joint, your healthcare provider may advise you to keep your shoulder immobilized in a sling or other device for several weeks after treatment. Resting and applying ice to the affected area several times a day will help your pain and swelling diminish.

After your pain and swelling subside, you may need to do some rehabilitation exercises to help restore your shoulder’s range of motion and strengthen your muscles.

When should I call my healthcare provider?

You should contact your healthcare provider if you have the following symptoms:

  • Swelling and/or pain in your shoulder, arm, or hand that worsens
  • Your arm or hand turns purple or pale
  • You have a fever

Key points

  • Dislocation of your shoulder means your upper arm bone (humerus) has come out of your shoulder joint.
  • Your shoulder can dislocate in several ways, including: forward and downward dislocation and backward dislocation.
  • A dislocated shoulder is very painful.
  • If you had a dislocated shoulder in the past, you are at greater risk for having it happen again.
  • After you have relieved your initial pain, rehabilitation exercises will help you prevent future dislocation.
  • Maintaining muscle strength and flexibility can help prevent shoulder dislocations.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

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You Can Head Off Stress Fractures

Whether you’re an avid basketball player or a weekend hiker, you may be at risk for a stress fracture if you overdo it.

A stress fracture occurs when you increase the length or intensity of your workout too quickly. Your muscles become so tired by the extra work that they transfer the stress to the bones — most often in the lower leg — and a tiny crack appears. A stress fracture can also happen when you workout on a different surface or use the wrong equipment for you, says the American Academy of Orthopaedic Surgeons (AAOS).

With proper rest, your bones have the time they need to repair any tiny fractures or grow stronger so they can take the wear and tear of an activity.

Doing too much too soon is a big mistake. In other words, it’s very important to have realistic expectations for your body.

Be sure to check with your healthcare provider before beginning a fitness program. Once you get the OK, don’t try to run 10 miles or join a football team if channel surfing has been your main activity for years. Start out slowly, and increase your level of activity gradually.

Building up slowly is also important to let your bones get used to the type of surface where you exercise. If you walk or run, for instance, start on flat and soft surfaces. Dirt paths tend to be better than asphalt, and asphalt can be better than concrete.

Invest in athletic shoes that provide good cushioning and support for the arches of your feet. Replace your shoes when they show signs of wear. Try to shop at stores that can offer guidance for your specific needs. Alternating your exercise program, or cross training with low impact activities can reduce the risk of a stress fracture.

Women seem to develop stress fractures more often than men, the AAOS says. That may be because women are more likely to have eating disorders and osteoporosis. As a woman’s bone mass reduces, the chances of getting a stress fracture increase. Make sure your diet provides enough calcium and vitamin D for strong bones.

If you’re in pain the minute you start walking or running and the pain doesn’t quiet down when you stop or after icing, it’s time to get help. Your healthcare provider can come up with a diagnosis and treatment to put you back on track. The most important treatment is rest. Most stress fractures take 2 to 4 weeks to heal with reduced activity and protective footwear. In some instances, certain bones may take up to 8 weeks to heal, depending on your situation.