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CORTICOSTEROIDS

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If you are not using cortisone injections as a part of your treatment strategy for common orthopedic conditions, I strongly urge you to start. Corticosteroid injections are a safe and effective treatment option for many orthopedic diagnoses. They are inexpensive, easy to administer, and often provide quick and long-lasting relief of the pain associated with arthritis, tendonitis, bursitis, and many other conditions. These injections are extremely useful tools that any practitioner caring for ailments of the musculoskeletal system ought to know and use.

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Frequency
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It is generally accepted that cortisone injections should be used judiciously. The specifics on this are somewhat vague. Some claim that the maximum frequency of injections for any one joint is one a month, not to exceed three per year. Others interpret the rule to be no more than one cortisone injection in any given joint every 4 months. The medical evidence supporting these guidelines remains elusive, but it is generally accepted that, given too frequently, cortisone can weaken connective tissue, including articular cartilage, tendons, and ligaments. What is even less clear is how many injections total a person can have (in any particular joint) in their lifetime. Some feel that patients should be limited to three injections (lifetime total) in any one joint. Others feel there is no lifetime limit, provided the rule of “one every 4 months” is not broken. Until a consensus can be reached, or until adequate medical evidence is put forth, it is certainly reasonable to inject any given joint with a maximum frequency of one injection every 4 months for a maximum duration of 3 years.

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Sterile Technique
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Proper sterile technique is important. The inside of a joint or tendon sheath is similar to an abscess cavity. It is a dead space with relatively poor circulation. Infections grow easily in such spaces, and cortisone is known to have a weakening effect on the immune system, so there is a higher risk of creating an infection with an intra-articular corticosteroid injection than, say, an intramuscular injection such as an immunization. That said, the risk of infection from in-office cortisone injections is surprisingly low, on the order of 1 in 15,000. The practitioner need not wear sterile gloves, although a pair of unsterile gloves is recommended because there is a risk that the practitioner will come in contact with the patient’s body fluids.

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Prep an area of skin at the proposed injection site with betadine or chlorhexidine, then lay an alcohol square over the site where you plan to inject. The alcohol square is important because you can press on it with your fingertip and confirm that you are in the right spot without actually touching the sterile patch of skin where the needle will enter. When you are ready to inject, slide the alcohol square out of the way and proceed to pass the needle through ...

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