Marc Darrow MD,JD

Systemic and local side-effects of corticosteroid injections including joint destruction

A patient will often come into our office with conflicting ideas about cortisone injections. The patient will tell us that his/her other doctors told them that cortisone injections are safe, effective, and will help their pain, if used sparingly. But, intuitively, the patient had doubts and concerns.

But as this patient continued to wait for a surgery, decisions had to be made as to how much pain management would be needed to “hold them over,” until the surgical date.

Corticosteroids are powerful anti-inflammatory substances. They are not used to relieve pain, but rather, to reduce inflammation, which in turn can lessen a patient’s level of discomfort. Numerous studies over the years have shown that prolonged use of cortisone will eventually cause degenerative joint disease in the joints they are injected into.

UNDERSTANDING THE POSSIBLE COMPLICATIONS OF CORTISONE INJECTIONS.

A December 2020 paper in the medical journal Radiology (1) says this:

• Current management of osteoarthritis is primarily focused on symptom control.
• Intra-articular corticosteroid injections are often used for pain management of hip and knee osteoarthritis in patients who have not responded to oral or topical analgesics.
• “Recent case series suggested that negative structural outcomes including accelerated osteoarthritis progression, subchondral insufficiency fracture (stress fractures in the bone beneath cartilage), complications of pre-existing osteonecrosis, and rapid joint destruction (including bone loss) may be observed in patients who received Intra-articular corticosteroid injections .
• The true cause and natural history of these complications are unclear and require further study. To determine the cause and natural history, large prospective studies evaluating the risk of osteoarthritis or joint destruction after Intra-articular corticosteroid injections are needed.

Read More

Marc Darrow MD,JD

Traditional methods of treating Carpal Tunnel Syndrome include wearing a splint at night or injections of cortisone to reduce swelling. If these measures are not successful, carpal tunnel release surgery, which sections the tough transverse carpal ligament and relieves pressure on the median nerve, may be performed. Despite some people having good success with surgery, there have been many patients who have presented to my office with worse symptoms after they had the carpal tunnel surgery.
Study: Surgeons confident Carpal Tunnel Surgery is a good option for patients, but not for them.

Read More

Marc Darrow MD,JD

We have seen many patients over the years who were looking for options to an arthroscopic wrist surgery for their unresolved wrist pain. They, like you perhaps, had a wrist pain that an MRI could not explain and their doctors felt that exploratory arthroscopic surgery may help find this pain. While the surgeons explored, the hope is that they may come upon something that they could repair. Whether or not that was the cause of the patient’s wrist pain, could not be confirmed until after the recovery period.

This type of surgical option is also one that many parents are trying to avoid for their young athlete. You may imagine that an athlete, with a small time table to return to sport would not want to chance a surgery and recovery where the outcome may be in doubt.

We offer non-surgical options to unresolved wrist pain. Stem cell therapy and Platelet Rich Plasma Therapy. In this article I want to present our research findings on the effects of Platelet Rich Plasma Therapy on unresolved chronic wrist pain published in the journal Orthopedic & Muscular System: Current Research (March 2019).
Read More