Steroid injection knee dosage

Although generally well tolerated, there are risks involved with a steroid injection. Infection and bleeding are risks with any injection. Though rare, a “flare” of increased pain after the injection can also occur. This flare generally subsides within 3 days. If this happens to you, call your doctor. Steroid injections can also raise your blood glucose level for a few days so if you have diabetes, you should discuss this potential risk with your doctor. There are other risks involved. For example, if you are on a blood thinner like warfarin, you may need to discontinue it prior to the injection.

Timothy E. McAlindon, ., ., of Tufts Medical Center, Boston, and colleagues randomly assigned 140 patients with symptomatic knee osteoarthritis with features of synovitis to injections in the joint with the corticosteroid triamcinolone (n = 70) or saline (n = 70) every 12 weeks for two years. The researchers found that injections with triamcinolone resulted in significantly greater cartilage volume loss than did saline (average change in cartilage thickness of - mm vs - mm) and no significant difference on measures of pain. The saline group had three treatment-related adverse events compared with five in the triamcinolone group.

Hyaluronic acid (HA) can also be injected into knee joints, but HA is a bit more contentious. HA is a very long-chain molecule, which makes it very oily and viscous. When it first became available, there were two main companies selling it; one sold it as a ‘medical product’, saying that it acted as a mechanical lubricant, effectively ‘oiling’ the knee joint. The other company registered it as a drug, saying that it had a pharmaceutical effect in the knee, like a painkiller. Either one of these companies was right and the other wrong, or maybe both were a bit right, or maybe they are both wrong?!

We’ve known for awhile that local anesthetic and steroid shots can produce side effects for stem cells and cartilage cells . Local anesthetics are a common component of knee steroid shots. We’ve been amazed at the toxicity of one commonly used numbing agent in knee steroid shots called Bupivicane (also known as Marcaine). A recent literature review on the topic I performed for another project was so unbelievable, I thought I had to share these studies. In one study,  Chu et al. confirmed a lasting toxic effect of bupivacaine on  cartilage cells in an animal joint. A full 6 months after they injected a knee joint with a single usual dose of bupivacaine , cartilage in the treated joints had a 50% lower density of chondrocytes (cartilage cells) compared with cartilage in control joints. Talk about side effects! Think about that for a second. A common numbing agent that gets injected into knee joints everyday because it lasts a little longer than other numbing medicines, was able to wipe out 50% of the cartilage cells by 6 months? Even if it only killed off 5% of the cells that would be equivalent of dropping a nuclear bomb inside the knee joint. How about other numbing medicines like Lidocaine? While this is a bit better than Bupivicane, local anesthetics containing l idocaine are significantly more toxic to mature human joint cartilage cells than a saline injection. How about the most common injection given in the United States for a swollen or painful joint with knee arthritis? Usually doctors will combine a steroid medication with a numbing agent like lidocaine and inject these to control pain and swelling. However, the combination of the steroid shot and local anesthetics has an synergistic adverse effect on cartilage  causing serious knee steroid injection side effects.  This means that the combination of anesthetic and steroid hits the knee joint cartilage cells harder than simply adding up the negative impact of each component. Another common practice is for pain management doctors to inject steroids and anesthetics into a neck or back facet joint (the small joints found at each spinal level). However, a lab study has now shown that these medications also may  hit the cartilage in these small joints as well . The upshot? We abandoned the use of Bupivicane several years ago and will only use low doses of lidocaine. We’ve also stayed away from using any anesthetics around stem cells. This new data has now forced us to get rid of even the lidocaine from our joint injections. We’ve spent hours searching the medical literature for a numbing agent that won’t hurt cartilage and have finally found one. We’ll begin using this new numbing agent in all of our joint procedures next week.

For many people, back pain goes away on its own or with nonsurgical treatments. Epidural steroid injections shouldn't typically be used as a first-line therapy for back pain relief, but that doesn't mean they can't play a role in treating pain. But injections won't cure the underlying cause of back pain, and they provide only temporary relief. Unfortunately, in many cases, chronic back pain can't be cured, but must instead be managed, like other chronic conditions—and patients must have realistic expectations of what epidurals can do.

Steroid injection knee dosage

steroid injection knee dosage

We’ve known for awhile that local anesthetic and steroid shots can produce side effects for stem cells and cartilage cells . Local anesthetics are a common component of knee steroid shots. We’ve been amazed at the toxicity of one commonly used numbing agent in knee steroid shots called Bupivicane (also known as Marcaine). A recent literature review on the topic I performed for another project was so unbelievable, I thought I had to share these studies. In one study,  Chu et al. confirmed a lasting toxic effect of bupivacaine on  cartilage cells in an animal joint. A full 6 months after they injected a knee joint with a single usual dose of bupivacaine , cartilage in the treated joints had a 50% lower density of chondrocytes (cartilage cells) compared with cartilage in control joints. Talk about side effects! Think about that for a second. A common numbing agent that gets injected into knee joints everyday because it lasts a little longer than other numbing medicines, was able to wipe out 50% of the cartilage cells by 6 months? Even if it only killed off 5% of the cells that would be equivalent of dropping a nuclear bomb inside the knee joint. How about other numbing medicines like Lidocaine? While this is a bit better than Bupivicane, local anesthetics containing l idocaine are significantly more toxic to mature human joint cartilage cells than a saline injection. How about the most common injection given in the United States for a swollen or painful joint with knee arthritis? Usually doctors will combine a steroid medication with a numbing agent like lidocaine and inject these to control pain and swelling. However, the combination of the steroid shot and local anesthetics has an synergistic adverse effect on cartilage  causing serious knee steroid injection side effects.  This means that the combination of anesthetic and steroid hits the knee joint cartilage cells harder than simply adding up the negative impact of each component. Another common practice is for pain management doctors to inject steroids and anesthetics into a neck or back facet joint (the small joints found at each spinal level). However, a lab study has now shown that these medications also may  hit the cartilage in these small joints as well . The upshot? We abandoned the use of Bupivicane several years ago and will only use low doses of lidocaine. We’ve also stayed away from using any anesthetics around stem cells. This new data has now forced us to get rid of even the lidocaine from our joint injections. We’ve spent hours searching the medical literature for a numbing agent that won’t hurt cartilage and have finally found one. We’ll begin using this new numbing agent in all of our joint procedures next week.

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