Steroid injections used to treat joint pain can do more harm than good

After shaking her right shoulder after cleaning her shower, Abigail Drummond was in a lot of pain.

& # 39; It was unbearable & # 39 ;, the 60-year-old former model recalls. An x-ray did not find any broken bones, but when the pain persisted, she decided to use her private health care to make a more detailed MRI scan.

This showed two tendons in her shoulder were severely torn and another severely damaged. All doctors offered was a steroid injection – a treatment used to reduce inflammation.

But now, six weeks after the accident, the injection has not only brought much relief, but Abigail has been told she actually needs surgery – but she has to wait because of the steroid injection. The injection may also have reduced the chance of the operation being successful, and also increased the risk of having an infection.

Abigail Drummond said she jerked her right shoulder when she slipped cleaning her shower, tore two tendons in her shoulder (stock image)

Abigail Drummond said she jerked her right shoulder when she slipped cleaning her shower, tore two tendons in her shoulder (stock image)

& # 39; To say I was upset would be an absolute understatement & # 39 ;, says Abigail from East London. & # 39; My shoulder movement is so limited that I cannot hold my arm or even ride. Now I am in a kind of limbo. & # 39;

Steroid injections are often given for chronic sore shoulders as well as other aches and pains such as arthritic knees.

The injections contain a corticosteroid, which reduces pain by reducing inflammation. Although they work for many, there is good evidence to show that in some circumstances they can cause more harm than good.

Exactly this month, a study in Arthroscopy: The Journal of Arthroscopic & Related Surgery found that patients who received injections prior to surgical repairs to the rotator cuff – a group of muscles and tendons around the shoulder – were more likely to have a revision operation (repeat the operation to to repair an earlier operation).

This research followed last year at a meeting of the American Orthopedic Society for Sports Medicine in New Orleans, where people who have revealed injections for less than six months before a repair to the rotator cuff have an increased risk of revision surgery.

& # 39; The problem with steroid injections is that they inhibit cells that can help repair damaged tissue and therefore weaken tendons and muscles & # 39 ;, says Tony Kochhar, an orthopedic surgeon at London Bridge Hospital, and a professor sports science at the University of Greenwich. & # 39; All of this can hamper healing and affect the success rates of surgical recovery. Therefore, they should not be administered without thinking about the bigger picture. & # 39;

The steroids in the puncture also suppress the local immune response, Professor Kochhar adds.

Steroid injections are often given for chronic sore shoulders as well as other aches and pains such as arthritic knees (stock image)

Steroid injections are often given for chronic sore shoulders as well as other aches and pains such as arthritic knees (stock image)

Steroid injections are often given for chronic sore shoulders as well as other aches and pains such as arthritic knees (stock image)

Indeed, research published in the Journal of Shoulder and Elbow Surgery in 2016 found that there was a significant increase in post-operative infection in patients who had steroid injection three months prior to shoulder arthroscopy (spinal surgery used to treat joint problems). diagnosing and treating) and arthroplasty (joint replacement).

But their use has not only been challenged. A 2016 study in the Journal of the American Medical Association found that steroid injections given every three months were no better than a placebo for relieving knee pain in patients with osteoarthritis. However, these injections are often offered before surgery is mentioned.

& # 39; If someone needs a knee replacement but first needs a steroid injection, it is advisable to postpone surgery for six months to reduce the risk of infection & # 39 ;, says Daniel Cohen, an orthopedic surgeon in the Royal Oldham Hospital and BMI The Highfield Hospital. And in general with an operation, the longer you wait for the operation, the less successful the outcome.

& # 39; Steroid injections have their place & # 39 ;, Mr. Cohen adds. But if someone had fallen and was in pain, for example, they should not receive an injection afterwards.

& # 39; That is because without a thorough examination and appropriate examination, such as a scan, a steroid injection can mask symptoms that require surgical procedures that cause a delay in treatment and possibly affect the long-term outcome & # 39 ;, the Mr Cohen.

& # 39; The problem is that these injections can be given too quickly. & # 39;

Professor Kochhar says that steroid jabs can be short-term anti-inflammatory pain killers in addition to physiotherapy, to make the exercises more feasible or in cases where surgery would not be considered.

He says, however, that patients should get the full benefits and drawbacks, because many will understandably choose an injection over an operation. & # 39; But an injection should not be viewed as having no after-effects. Many people seem to think that "if the injection does not work, I can still have surgery without adverse consequences," but this is often not the case, "he says.

Abigail now wished she knew more before she received her steroid injection.

It was only when she discussed her situation with another doctor who treated her for back pain that she was told that she should have been referred to a shoulder specialist, because this type of damage usually requires surgery.

She now has to wait months for her surgery and knows the chance that work will be reduced because she had the shot. & # 39; I am furious & # 39 ;, she says. & # 39; I just don't want anyone else to think that the so-called quick fix is ​​really what he promises to be. & # 39;