How are joint and soft tissue injuries treated prior to corticosteroid injection?

Updated: Mar 01, 2019
  • Author: Jess D Salinas, Jr, MD; Chief Editor: Elizabeth A Moberg-Wolff, MD  more...
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Answer

Answer

Treatment of the patient with an inflammatory condition involves a multidisciplinary approach. Anti-inflammatory medications (eg, aspirins, nonsteroidal anti-inflammatory drugs [NSAIDs], oral prednisone) are indicated in patients with acute and chronic inflammation. It should be remembered that a full therapeutic dose should initially be used. Many patients discontinue their medication after they have begun to feel better, leaving a low-lying inflammatory reaction. This author recommends first prescribing the NSAID for a 10- to 14-day period, with instructions to use up the medication as long as side effects do not develop. This should be followed up with an as-needed (prn) prescription.

Nonnarcotic pain medications, such as Elavil, may be beneficial in reducing the pain associated with inflammatory reactions. Although this is an area of some controversy, the use of narcotic medications is dependent on the severity of the pain, and these drugs should be used only for a limited duration.

In acute situations, rest, ice, heat, splinting, and bracing are important elements of care. With time, physical therapy, massage therapy, and general rehabilitation management become increasingly effective. While injection therapy is relatively safe, there are inherent dangers in any procedure where the skin is pierced, including infection, bleeding, joint ruptures, and perforation of vital structures.

A study by Ellegaard et al indicated that in patients with subacromial pain syndrome, the effectiveness of steroid injections is not improved by exercise therapy in the affected shoulder. The study included 99 patients, all of whom received injections, with no significant difference found in the visual analogue score for pain between the exercise intervention and control groups. [6]


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