injections

when are injections used to treat shoulder pain 62767f972a339

When Are Injections Used to Treat Shoulder Pain?

when are injections used to treat shoulder pain 62767f972a339

When Are Injections Used To Treat Shoulder Pain?

The answer to this question depends on the cause of your shoulder pain as well as the type of injection being considered.

There are two main types of injections used in and around the shoulder, these include steroid medications, which are the most common and PRP or “platelet rich plasma”.

Steroid is a type of medication that is used very frequently in medicine. Some forms of steroid are taken by mouth, some are used through an IV, and others are made to be injected into different locations, including into and around the shoulder joint. Steroids are actually naturally occurring, meaning that we normally have steroid in our body, but the type that is used for injections are slightly different and are made in a laboratory. Steroids work through the inflammation pathway, blocking several molecules that lead to inflammation, redness and pain. Therefore, they are very helpful for treating painful orthopedic conditions.

Dr. Johnny T. Nelson uses steroids for two main reasons in and around the shoulder.

The first reason is if the patient is in severe pain, sometimes this pain is so severe that the patient is not able to start or participate in physical therapy which may be the best treatment for that pain. Also, patients can have pain that is so severe that they cannot sleep, and they cannot work and provide for themselves. If that is the case, the decision is sometimes made to perform a steroid injection.

However in some patients, such as patients with large rotator cuff tears that may require surgery, Dr. Nelson sometimes avoids steroids because there is evidence that steroids impedes and prevents the healing that is necessary after shoulder surgery and rotator cuff repair surgery(1).

The second reason Dr. Nelson uses steroids is to identify the actual cause of your pain. Because there are so many structures in and around the shoulder that can cause pain, sometimes even with imaging, physical examination performed by your orthopedic surgeon, the actual cause of your pain may be unclear. A steroid injection around a structure may help to define or eliminate whether that structure is the cause of the pain. For example, Dr. Nelson often performs injections around the biceps tendon sheath under ultrasound, if the patient’s pain improves, it is very likely the biceps tendon is a cause of the pain.

Okay, what about platelet rich plasma?

Platelet rich plasma is a new technology that shows a lot of promise. Certain patients with certain problems around the shoulder can be candidates for platelet rich plasma therapy. These include patients with bad bursitis, inflammation, partial tearing of the rotator cuff, and even arthritis. Although the evidence for effectiveness of platelet rich plasma is limited because the technology is so new, it is a good nonsurgical treatment method to try in some situations.

Although platelet rich plasma is not usually covered by insurance, it is a simple process. It requires taking some of your own blood, spinning it down in a machine, and taking the portion of the blood that contains many special growth factors and other molecules and injecting it around the area that is painful and inflamed. This platelet rich plasma injection triggers an inflammatory response that after several weeks will quiet down, leaving the inflamed and painful area more quiet, healed, and less painful.

If you are having shoulder pain, call 919-872-5296 to schedule a visit with shoulder specialist Dr. Johnny Nelson. Before you see your primary care doctor, physical therapist, chiropractor, or other provider, it is important that you have a thorough history and physical examination by an orthopedic surgeon to establish the correct diagnosis!

References:
Puzzitiello RN, Patel BH, Nwachukwu BU, Allen AA, Forsythe B, Salzler MJ. Arthroscopy. 2020 May; 36(5):1468-1475. Epub 2019 Dec 17.

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will injections fix my shoulder elbow or hand problem 62767f776633c

Will Injections Fix my Shoulder, Elbow, or Hand Problem?

will injections fix my shoulder elbow or hand problem 62767f776633cWill injections fix my shoulder, elbow, or hand problem?

Steroid injections are commonly used in the treatment of shoulder, elbow and hand problems. As a result, there is some confusion about what these injections actually do for different conditions.

As a general rule, orthopedic surgeons such as Dr. Nelson use steroid injections for 3 main reasons:

1) To completely cure a condition, now and forever

2) To help relieve inflammation and pain that is unbearable for the patient, even if temporary

3) To help clarify exactly what condition the patient has and what structure is bothering them

What conditions can be completely cured with steroid injections?

Although we can never know and predict with 100% certainty that the steroid injection will cure a certain patient’s condition, we know that some conditions can be cured with a steroid injection. Problems that have high rates of cure with injection include tendinitis around the hand and wrist, including trigger finger. Problems with lower rates of cure include tennis and golfer’s elbow and shoulder biceps tendinitis, for example. Of course, the steroid injections are often administered along with recommendations for a period of rest, possibly bracing and icing, or physical therapy, which also may help the condition resolve.

Okay, so what conditions cannot be cured with steroid injections?

One of the most common reasons to perform injections around joints is arthritis, or wear and tear of the joint surface. It is important to understand that the steroid injection does not fix or reverse the arthritis. Arthritis is always there, and in fact tends to progress with time, no matter what you do. The main reason to perform injections for problems like wrist, hand, or shoulder arthritis is to “kick the can down the road,” temporarily reducing pain so that the patient can remain active, participate in physical therapy, and avoid resorting to surgical intervention.

Nerve problems also usually cannot be cured with steroid injections. For example, carpal tunnel syndrome is very common, and injections are often used to help reduce patient’s symptoms, especially if the carpal tunnel syndrome is due to a new or recent activity and the patient is not able to undergo a carpal tunnel release. But usually the carpal tunnel symptoms will usually return after a time.

So how can injections help clarify the cause of pain?

Sometimes even the best orthopedic surgeon has difficulty knowing with 100% certainty what structure is the cause of pain, or what the correct diagnosis is. Sometimes a good option is to perform an injection to clarify if a certain structure is the cause of pain. If an injection of steroid around the structure make the pain go away, even for a short time, this tells the patient and surgeon the injected structure is likely the cause. We also know that patients who have relief of their carpal tunnel symptoms, even temporarily, after injections are very likely to respond favorably to a carpal tunnel release with permanent relief of their symptoms.

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