Cortisone injections are probably one of the most misunderstood methods of treatment for arthritis. Cortisone is a natural hormone that adrenal glands make. These glands are the small glands on the top part of the kidneys. It is a natural substance that occurs naturally in the human body.
However, just like any other natural substance (including sugar, water and even oxygen) too much of it and/or inappropriate use of it can be harmful. Utilized in the proper way, it can be a very safe and effective treatment of the symptoms of arthritis. It will not grow back new cartilage or “cure” the arthritis (there really is no “cure” for arthritis). Since it is the most potent anti-inflammatory that we know of, by injecting it into the joint that is inflamed, it can decrease the inflammation thus decreasing the swelling and the pain. This allows patients to function better and, more importantly, perform their exercises, which is an integral part of the treatment of arthritis.
Cortisone also has some effect on the joint fluid helping it become a little bit more lubricating. When patients develop arthritis, the normal joint fluid thins out and is not as good a lubricant as it was prior to the arthritis. Usually two or three cortisone shots in the same area per year, if utilized appropriately, can be safe. However, just like any medication, its use needs to be monitored for potential side effects.
Hyaluronic acid is one of the more recent forms of arthritis treatment. It is a form of artificial joint fluid. It is only FDA approved for use in knees at this time. There are, however, patients who do well and have used it in their hips, shoulders, elbows, feet, ankles, etc., but again, it is not FDA approved for that purpose.
Interestingly, the hyaluronic acid is made from rooster combs. It is injected into the knee, and it thickens up the fluid of the joint similar to a “motor oil change.” However, it also stimulates the joint to produce better fluid so it tends to last longer than a cortisone shot or other forms of treatment. It does need to be injected into the joint, and it is usually a series of three to five injections. It usually lasts on average six months, but on some people, it doesn't work as well and on others it lasts longer. It can usually be repeated every six months if it is effective.
Perhaps the most underrated but most valuable form of non operative treatment for arthritis is physical therapy. The basic principal of physical therapy is to help decrease the inflammation, swelling and pain with certain modalities such as ice, heat, electrical stimulation, ultrasound, etc. The physical therapist will then try to improve range of motion and help stretch the joint to decrease the stiffness symptoms.
The mainstay and most important part of physical therapy are to strengthen the muscles around the joint. The stronger the muscles are, the more force they will absorb and less force goes across the damaged joint. You would be surprised how many patients I see who have bone on bone arthritis in their knees, for example, and come in stating, “I want a knee replacement.”
Even if they do end up needing a knee replacement, I still like to send them to physical therapy to strengthen their muscles and improve their range of motion prior to surgery. That way they will usually do better and recover faster after surgery.
They will also have the advantage of already knowing the exercises and not having to try to learn them with a large incision on the front part of their knee while in pain.
Interestingly, many of these patients end up getting much better to the point where they can function without needing a joint replacement. Sometimes they can't believe that a surgeon would prescribe a non operative form of treatment, but I think most people would agree as they would prefer not to have surgery if at all possible.
Speaking of surgery, I will discuss various surgical options for arthritis in the next article.
Dr. Marc P. Pietropaoli is a board
certified/fellowship trained orthopedic surgeon/sports medicine specialist and is president of Victory Sports
Medicine & Orthopedics in Skaneateles.
Cortisone also has some effect on the joint fluid helping it become a little bit more lubricating. When patients develop arthritis, the normal joint fluid thins out and is not as good a lubricant as it was prior to the arthritis. Usually two or three cortisone shots in the same area per year, if utilized appropriately, can be safe. However, just like any medication, its use needs to be monitored for potential side effects.
Hyaluronic acid is one of the more recent forms of arthritis treatment. It is a form of artificial joint fluid. It is only FDA approved for use in knees at this time. There are, however, patients who do well and have used it in their hips, shoulders, elbows, feet, ankles, etc., but again, it is not FDA approved for that purpose.
Interestingly, the hyaluronic acid is made from rooster combs. It is injected into the knee, and it thickens up the fluid of the joint similar to a “motor oil change.” However, it also stimulates the joint to produce better fluid so it tends to last longer than a cortisone shot or other forms of treatment. It does need to be injected into the joint, and it is usually a series of three to five injections. It usually lasts on average six months, but on some people, it doesn't work as well and on others it lasts longer. It can usually be repeated every six months if it is effective.
Perhaps the most underrated but most valuable form of non operative treatment for arthritis is physical therapy. The basic principal of physical therapy is to help decrease the inflammation, swelling and pain with certain modalities such as ice, heat, electrical stimulation, ultrasound, etc. The physical therapist will then try to improve range of motion and help stretch the joint to decrease the stiffness symptoms.
The mainstay and most important part of physical therapy are to strengthen the muscles around the joint. The stronger the muscles are, the more force they will absorb and less force goes across the damaged joint. You would be surprised how many patients I see who have bone on bone arthritis in their knees, for example, and come in stating, “I want a knee replacement.”
Even if they do end up needing a knee replacement, I still like to send them to physical therapy to strengthen their muscles and improve their range of motion prior to surgery. That way they will usually do better and recover faster after surgery.
They will also have the advantage of already knowing the exercises and not having to try to learn them with a large incision on the front part of their knee while in pain.
Interestingly, many of these patients end up getting much better to the point where they can function without needing a joint replacement. Sometimes they can't believe that a surgeon would prescribe a non operative form of treatment, but I think most people would agree as they would prefer not to have surgery if at all possible.
Speaking of surgery, I will discuss various surgical options for arthritis in the next article.
Dr. Marc P. Pietropaoli is a board
certified/fellowship trained orthopedic surgeon/sports medicine specialist and is president of Victory Sports
Medicine & Orthopedics in Skaneateles.
Citizen
Hot Jobs
New! Off the Menu
The Citizens' Say
Post your comment - click hereThere are No comments posted.