Steroids knee injections

I have a suspicion, after reading many of your notes on injectable steroids, that I seem to have developed a type of “tendonitis” in my upper arms due to multiple elbow steroid injections. I have had 4 in my left elbow (worst arm) and 2 in my right, about 5yrs ago. I have been having this tendon problem for about one year now, and not one doctor can figure out what’s wrong. One actually said “it seems like tendonitis”, but no cause or cure was suggested. The steroid injections is the only common denominator here. The right arm is affected as well, but not nearly to the degree of the left (and I’m right handed, so maybe the strong arm is less affected, plus I only had 2 injections there). Is there hope for acute tendonitis in my bicep/tricep area?

The aim of knee osteotomy is to change the weight distribution of the knee to from an area of arthritis to an area which is unaffected. This is achieved by either cutting the bone above or below the joint, and fixing it with a plate and screws at a different, pre-determined angle. To achieve a good result, there must be an area of good cartilage to shift the load to, and the meniscus of that compartment must be intact. This operation is most suitable for patients who are young and wish to perform strenuous activity, such as manual labourers. Patients are unable to fully weight bear for 6 weeks until the osteotomy heals.

A recent Spanish study  also showed that hyaluronic acid injections are an economic booster to health systems as they delay the need for joint replacement. In essence, unlike toxic steroids and anesthetics, they are a net positive to the joint. So if you want to get knee gel injections before a knee stem cell injection , they will likely help the effort of cleaning up a toxic arthritic knee. However, there are two key rules you need to follow: guidance and making sure the doctor doesn’t add anything cartilage toxic to the HA. First, guidance means that the doctor uses ultrasound or x-ray to make sure he or she is actually placing the medication in the joint . Why? The rate of the doctor actually missing the joint will go up or down with the injection route taken and the weight of the patient. The “miss rate” can be as high as 20-40%! In addition, if the doctor gets the HA outside the joint, the risk for bad complications can go way up as some of the medications if placed outside the joint can cause a “pseudoseptic joint” (a red and angry joint that looks like it’s infected but really isn’t). Second, and perhaps even more important, is that the doctor adds nothing toxic to the knee gel injections. It’s very common for example for physicians to add a local anesthetic to the HA because they believe it will help with post injection soreness. First, all common local anesthetics are toxic to the joint’s stem cells and many are also toxic to the cartilage. The most commonly used anesthetic for joints is Marcaine/Bupivicaine and it’s highly toxic to both stem cells and cartilage cells! In addition, many doctors will want to add a high dose steroid, which is also toxic to stem cells and cartilage cell s. So injecting the good HA is made bad by adding joint toxic substances to the mix!

Using tritiated glycine (glycine 3H) as an indicator of amino acid incorporation in protein synthesis in cartilage matrices, Mankin and Conger injected hydrocortisone acetate into rabbit knees. Their data showed a rapid and profound decrease in glycine incorporation that appeared to depend on dosages. Maximum decline was seen six hours after the injection. 28  They did a similar experiment using glycine 14C as the radiotracer, which showed a definite decrease in the rate of protein synthesis within two hours of the injection. They noted that the rate of the inhibitory effect of intraarticular hydrocortisone on cartilage protein synthesis was about twice that of the observed rate for corticosteroids given by intramuscular route. 29  One year later, researchers injected hydrocortisone into normal rabbit knees and produced thinning of the cartilage, and the development of fissures and fibrillations in the articular cartilage. They also found multiple small white deposits within the substance of the articular cartilage, which were found to represent cystic areas of degeneration within the middle zone of the cartilage matrix. These effects were most marked in the animals which had the greatest number of injections. 30 Deleterious effects of cortisone were reported by some researchers who noted that the drug inhibited the synthesis and deposition of chondroitin sulfate in cartilage. 31-33

Steroids knee injections

steroids knee injections

Using tritiated glycine (glycine 3H) as an indicator of amino acid incorporation in protein synthesis in cartilage matrices, Mankin and Conger injected hydrocortisone acetate into rabbit knees. Their data showed a rapid and profound decrease in glycine incorporation that appeared to depend on dosages. Maximum decline was seen six hours after the injection. 28  They did a similar experiment using glycine 14C as the radiotracer, which showed a definite decrease in the rate of protein synthesis within two hours of the injection. They noted that the rate of the inhibitory effect of intraarticular hydrocortisone on cartilage protein synthesis was about twice that of the observed rate for corticosteroids given by intramuscular route. 29  One year later, researchers injected hydrocortisone into normal rabbit knees and produced thinning of the cartilage, and the development of fissures and fibrillations in the articular cartilage. They also found multiple small white deposits within the substance of the articular cartilage, which were found to represent cystic areas of degeneration within the middle zone of the cartilage matrix. These effects were most marked in the animals which had the greatest number of injections. 30 Deleterious effects of cortisone were reported by some researchers who noted that the drug inhibited the synthesis and deposition of chondroitin sulfate in cartilage. 31-33

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