What Is a Cortisone Shot?

What Is a Cortisone Shot?

Cortisone shots can potentially provide long-lasting relief from pain and inflammation in the joints.

Many injections can greatly reduce pain and inflammation caused by musculoskeletal injuries or chronic conditions such as arthritis, significantly shortening recovery timelines and providing lasting relief. One shot we particularly recommend to patients entails an injection of cortisone into a damaged joint. We’ll tell you what you need to know about this tried-and-true treatment for pain and inflammation in the joints.

What Is a Cortisone Shot?

A cortisone shot is an injection composed of a corticosteroid medication and a local anesthetic. Used to relieve pain and inflammation, it’s most commonly injected into a joint, often in the shoulder, hip, or knee. These shots are often one option in a comprehensive treatment plan for chronic inflammatory conditions such as arthritis, tendinitis, or rotator cuff impingements or tears.

How Long Does a Cortisone Shot Last?

A cortisone shot’s effectiveness depends on the severity of the patient’s condition. In most cases, pain and inflammation will marginally increase for about 48 hours following the injection, and will decrease precipitously thereafter. In some cases, a single injection can provide relief for as long as several months.

Generally, cortisone shots should only be given two times per joint per year. Repeated cortisone injections can damage the cartilage in the joint.

What Are the Side Effects of a Cortisone Shot?

Cortisone shots are typically safe in moderation, but since they infrequently lead to serious complications, they should be taken under a doctor’s supervision. Be sure to let your doctor know if you suffer from diabetes or other any other conditions affecting your blood sugar levels, as well as any medications that you are currently taking.

Most cortisone shots have some minor side effects, including a temporary uptick in pain and inflammation in and around the joint, and a thinning and lightening of the skin around the site of the injection. In some cases, however, they can result in a sudden spike in blood sugar if you’re diabetic and have poorly controlled blood sugar levels. .

What If the Cortisone Shot Doesn’t Work?

Cortisone shots provide a source of temporary relief from inflammation and pain. They will not solve the underlying problem, and pain may gradually return as the shot’s effectiveness subsides. As a result, cortisone shots should be administered as part of a more comprehensive treatment plan that may include physical therapy or surgery.

Fortunately, our team of orthopedic specialists at Comprehensive Orthopaedics has several years of experience in treating joint problems. Regardless of your specific condition, we’ll work with you to develop a personalized treatment plan that provides lasting relief from your symptoms.

Don’t Delay Hip Fracture Surgery. Here’s Why

Don’t Delay Hip Fracture Surgery. Here’s Why

Seniors with a fractured hip need surgery as soon as possible or they could suffer life-threatening complications, a new Canadian study concludes.

Having surgery within 24 hours decreases the risk of hip fracture-related death. It also lowers odds of problems such as pneumonia, heart attack and blocked arteries, the researchers found.

“We found that there appears to be a safe window, within the first 24 hours,” said lead researcher Daniel Pincus, a doctoral student with the University of Toronto.

“After 24 hours, risk began to clearly increase,” Pincus said.

U.S. and Canadian guidelines recommend hip fracture surgery within 48 hours of injury, but it’s likely that many people don’t receive care that quickly, he noted.

In the United Kingdom, guidelines call for surgery within 36 hours, but hospitals often fail to get patients promptly into the operating room, Pincus added. Rates range from 15 percent to 95 percent among U.K. hospitals, according to the report.

Oftentimes, there’s no operating room or surgeon available, or other patients are awaiting surgery, Pincus explained.

“There’s a triage system and these patients historically were not prioritized,” he said. “Sometimes there’s medical reason for the delay, but that’s very rare. We’re starting to realize there’s almost no reason why a patient should be delayed.”

Delay also likely occurs because doctors approach these elderly patients with a good deal of caution, said Dr. Harry Sax. He is executive vice chair of surgery for Cedars-Sinai Medical Center in Los Angeles.

“The perception is that if you’re old and you’ve broken your hip, that you’re going to have a lot of other [health problems],” said Sax, co-author of an editorial accompanying the new study. “Therefore, I need to spend several days running tests on you to try to make sure I can get you through the hip fracture surgery. ”

To see how this delay affects the health of patients, Pincus and his colleagues evaluated data on over 42,000 people treated for hip fracture at 72 hospitals in Ontario between April 2009 and March 2014. The patients’ average age was 80.

The investigators compared patients based on whether they had surgery before or after 24 hours.

Overall, about 12 percent of hip fracture patients died within the month following their surgery.

However, patients who got surgery within 24 hours were 21 percent less likely to die during the following month, compared with those who had a delay in surgery, the findings showed.

Those patients also had lower complication rates. They were 82 percent less likely to develop a blood clot in the leg veins (deep vein thrombosis); 61 percent less likely to have a heart attack; and 49 percent less likely to suffer a blood clot in the lung (pulmonary embolism). They were also 5 percent less likely to develop pneumonia during the month following surgery.

“The problem is the longer you sit in bed, the more likely you are to get pneumonia and blood clots. The unfixed bone is continuing to flick off little bits of fat, which can go to the lungs,” Sax said. “The delay doesn’t necessarily make things better. It could make things worse.”

People with an elderly relative facing hip fracture surgery should ask the health care team to get their loved one into surgery as soon as possible, with as little additional testing as possible, Pincus and Sax said.

“A prompt evaluation to make sure there’s nothing quickly correctable should be done, but otherwise the patient should move to the operating room as quickly as possible,” Sax said.

Families should ask doctors about every test, scan or screen that delays the surgery, Sax said.

“The question needs to be, what is the information that you’re going to gain and how would that change your management of this patient,” Sax said. “There are very few things you find with all this expensive testing that you can do anything about.”

The patient would be best off in a hospital that has a specific program to manage elderly people with hip fractures, Sax added. These programs have a team of surgeons, geriatricians, anesthesiologists and other professionals well-versed in the procedure.

“If you can find a hospital that does that, the chances are your outcomes are going to be better,” Sax said.

The study was published Nov. 28 in the Journal of the American Medical Association.

More information

For more on hip fractures, visit the American Academy of Orthopaedic Surgeons.

SOURCES: Daniel Pincus, doctoral student, University of Toronto, Ontario, Canada; Harry Sax, M.D., executive vice chair, surgery, Cedars-Sinai Medical Center, Los Angeles; Nov. 28, 2017, Journal of the American Medical Association

Ditch the Throw Rugs, Seniors!

Ditch the Throw Rugs, Seniors!

Icy winter weather may lead to fewer hip fractures than many believe.

Most fall-related hip fractures among elderly people in a New England study occurred in warm months and indoors — with throw rugs a common culprit.

“Given the results of this study, it appears that efforts to decrease fall risk among the elderly living in cold climates should not be preferentially aimed at preventing outdoor fractures in winter,” said study author Dr. Jason Guercio.

Instead, preventive efforts should focus on conditions present year-round, and especially on indoor risk, said Guercio. He’s with North American Partners in Anesthesiology at the Hospital of Central Connecticut in New Britain, Conn.

The researchers analyzed details about hip fractures suffered by 544 patients treated at the Hospital of Central Connecticut between 2013 and 2016.

More than 55 percent of the hip fractures occurred during warm months, with the highest rates in May, September and October (around 10 percent each). In addition, the investigators found that more than three-quarters of the hip fractures occurred indoors.

Moreover, 60 percent of outdoor fractures occurred from May through October, not in the depths of winter.

The most common cause of both indoor and outdoor hip fracture? Tripping over an obstacle. Indoors, throw rugs were the most common obstacle cited.

Falling out of bed was the second leading cause of indoor hip fractures.

Outdoors, the other leading causes of hip fractures were being struck by a vehicle or falling from a vehicle, followed by accidents on stairs.

The study was scheduled for presentation Monday at the annual meeting of the American Society of Anesthesiologists, in Boston.

“Falls are one of the most common health concerns facing the elderly today. And this population is the fastest growing segment of the U.S.,” Guercio said in a meeting news release.

“Falls leading to fracture can result in disability and even death. Understanding the risk factors for fractures can help to focus efforts on decreasing them, and guide resources and appropriate interventions to prevent them,” Guercio said.

“It is counterintuitive that the risk for hip fracture would be higher in warm months, as ice and snow would appear to be significant fall risks,” he added.

Research presented at meetings should be considered preliminary until published in a peer-reviewed medical journal.

More information

The U.S. Centers for Disease Control and Prevention has more on hip fractures among older adults.

SOURCE: Anesthesiology annual meeting, news release, Oct. 23, 2017

Preventing Sports Injuries

Preventing Sports Injuries

Exercise is good for the body and with the proper precautions, sports injuries can often be prevented. The quality of protective equipment – padding, helmets, shoes, mouth guards – have helped to improve the safety in sports. But, you can still be susceptible to injury. Always contact your healthcare provider before starting any type of physical activity, especially vigorous types of exercises or sports.

Causes of sport injuries may include:

  • improper or poor training practices
  • wearing improper sporting gear
  • being in poor health condition
  • improper warm-up or stretching practices before a sporting event or exercise

Common sports injuries include:

  • Sprains and strains
  • Joint injuries (knee)
  • Muscle injuries
  • Dislocations
  • Fractures
  • Achilles tendon injuries
  • Pain along the shin bone

How can I prevent a sports injury?

The following are some basic steps to prevent a sports injury:

  • Develop a fitness plan that includes cardiovascular exercise, strength training, and flexibility.  This will help decrease your chance of injury
  • Alternate exercising different muscle groups and exercise every other day.
  • Cool down properly after exercise or sports. It should take 2 times as long as your warm ups.
  • Stay hydrated. Drink water to prevent dehydration, heat exhaustion, and heat stroke.
  • Stretching exercises can improve the ability of muscles to contract and perform, reducing the risk for injury. Each stretch should start slowly until you reach a point of muscle tension. Stretching should not be painful. Aim to hold each stretch for up to 20 seconds.
  • Use the right equipment or gear and wear shoes that provide support  and that may correct certain foot problems that can lead to injury.
  • Learn the right techniques to play your sport.
  • Rest when tired, Avoid exercise when you are tired or in pain.
  • Always take your time during strength training and go through the full range of motion with each repetition.
  • If you do sustain a sports injury, make sure you participate in adequate rehabilitation before resuming strenuous activity.
Health Tip: Reduce Your Risk of Hip Fracture

Health Tip: Reduce Your Risk of Hip Fracture

Hip fractures are serious injuries, especially in seniors. Falls are a prime cause.

The American Academy of Orthopaedic Surgeons offers this advice on reducing your risk:

  • Keep your home clear of clutter, making sure it is well lit. Install grab bars in bathrooms.
  • Get regular exercise to strengthen bones and muscles, and improve balance.
  • Each year, get an eye exam and a complete physical.
  • Discuss all medications with your doctor, as some drugs can have side effects.
  • Know your risk factors for bone loss and fractures.
  • Eat a healthy diet rich in vitamin D and calcium. If needed, talk to your doctor about medication to improve bone health.
  • Maintain a healthy weight.

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.