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Steroid injections

Many people who have a problem with their hands will need a steroid injection to help alleviate that problem.
 
In my experience, most people don’t want a steroid injection, and rightly so, they are painful. But oftentimes they are very helpful for a variety of hand conditions, and can help reduce pain, lessen the need for surgery, or provide a cure altogether.

This entry will discuss what a steroid injection is in general, and some of the most common conditions in the upper extremity that they are used for. Please note, in some cases steroids can be the cure, and in other cases, steroid are generally considered palliative, that is they help reduce pain and symptoms, but they are generally not considered a long-term, or curative solution.

What are steroids anyway?

Most people think of Mark McGuire crying in front of Congress, or Barry Bonds’ oversized head when they think of steroids, but these are anabolic steroids, and they are not the steroids that are generally used in a doctors office when you get a steroid injection for pain, what is also commonly referred to as a “cortisone” shot.

Most doctors do not use cortisone, anymore, either. There are many newer steroids that have been developed that are more potent, or have been chemically synthesized to stay in the tissues longer, and thus be mroe effective.

The most common ones used in my practice are decadron, celestone, kenalog, and depo-medrol.

Though steroids injections are generally safe, there are a few complications you should know about:

  1. They can blanche the skin. Often this is transient, but it can take up to a year to resolve.
  2. They can make your blood sugar go up if you are diabetic.
  3. They hurt. You know this, already, but some of the singing can persist for a few days until the steroids kick in, so to speak.
  4. They can cause tendon rupture. This can be obviated by using the right indication to give steroids and giving it in the proper place. A hand surgeon should give most of the steroid injection of in the hand.
  5. Related to point 4, a carpal tunnel steroid injection that is poorly placed by an inexperienced clinician can result in nerve injury. This, though rare,  is a serious condition that can cause permanent side effects. Have someone really familiar with the process do this injection for you, if you need it.
  6. Then I’ll avoid steroid injections, and take the pills. That is something that I have heard from patient, but remember steroid pills have side-effects too: they upset your stomach, they cause insomnia, and you can gain weight on the steroid pills, just to name a few. Talk with you doctor about these things. Sometimes a little pain is okay.

What are some of the conditions that I use steroids for?

  1. Carpal tunnel syndrome: They are not considered curative, lasting usually a few months to a year. The nerve remains “pinched” in spite of the injection.
  2. Trigger Finger: Steroid injections are generally curative, but sometimes a patient needs 2-3.
  3. Tendinitis: Generally, steroids with rest and physical therapy can be curative in many cases, though depending on the specific form, sometimes surgery is necessary.
  4. Tennis Elbow: Often surgery is not necessary, but frankly, many times it is. Of all the conditions mentioned, steroid have the least predictable result, and need to be given 2-3-4 times, along with rest and splinting. Sometimes it works well, but results are usually seen over months and not weeks.
  5. Arthritis: Steroid are palliative in most cases, but they generally work for long periods of time, and surgery is not usually indicated in early cases. Therefore, people often get many steroid injections over many years before they become candidates for surgical intervention.
  6. Hand Pain, not otherwise specified: After a sprain or contusion, pain in the hand can last for many months. A dislocated finger can be painful for 4-6 months in some people. If people are extremely active with their hands, a steroid injection can help provide long term pain relief, so that a patient doesn’t need to take OTC pain meds like Tylenol and Ibuprofen chronically.

I hope this entry was helpful, and you will email me with your questions.

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