Will Injections Help or Do I Need Surgery? The Straight Facts About Cortisone Shots

Cortisone is a potent anti-inflammatory medication that can be used to treat a wide range of orthopedic conditions, but Cortisone shots are not a one-size-fits-all solution. For some patients, injections can be highly effective, but in other cases it may be time to consider surgery.

According to orthopedic surgeon Dr. Noerdlinger, there are three common misconceptions people have about cortisone shots:

1. Cortisone is Just Temporary

Although the effects can be temporary, there are cases where Cortisone can offer long lasting pain relief for years.

2. Cortisone Only Masks the Pain

Novocain, such as lidocaine, will mask pain, but Cortisone decreases the inflammation which is causing the pain. The analogy is taking a steroid to decrease the inflammation from a sore throat. The steroid effect of the Cortisone decreases the inflammation and allows the joint to move more freely, enabling the patient to rehabilitate the joint more effectively.

3. Cortisone Damages Tissue

Used judiciously, cortisone will not damage tissue. Just like taking a bottle of Tylenol will destroy the liver, large amounts of cortisone–in a short time period, in the same body part–can weaken the collagen fibers. But, like Tylenol, where it is ok to finish off the bottle over the course of a year, intermittent Cortisone injections are permissible.

While Cortisone shots can be incredibly beneficial for some, there are situations where surgical intervention may be necessary:

1. Loss of Function

If your orthopedic condition has progressed to the point where it severely limits your ability to participate in daily activities and compromises your quality of life, it may be time to consider surgery.

2. Structural Damage

In patients with significant structural damage to a joint, such as advanced osteoarthritis with bone-on-bone contact, joint replacement surgery may be the best solution to restore function and relieve pain.

3. Repeated Injections are Ineffective

If you find yourself needing frequent Cortisone injections for the same issue, it indicates that the underlying problem can’t be managed with injections alone. If Cortisone offers only temporary relief, it might be time to have a discussion with your orthopedic specialist about surgical options.

Cortisone is a valuable tool in orthopedic care, providing pain relief and delaying the need for surgery in some patients. But it’s important to recognize the limitations of injections and to know when it’s time to consider the next step–surgical intervention like joint replacement. One scenario in which cortisone injections are not recommended is in the setting of fixable rotator cuff tears in patients considering surgery. Studies show that re-rupture rates and infection rates are higher in patients undergoing rotator cuff repairs who receive cortisone injections before surgery.

Your orthopedic specialist is your best resource in determining the most appropriate treatment plan for your specific condition, symptoms, and goals. Whether it’s cortisone injections or joint replacement surgery, the ultimate aim is to help you regain function, eliminate pain, and enjoy a high quality of life.

Platelet-Rich Plasma (PRP) Injections Help the Body Heal Itself

What Are Platelet-Rich Plasma (PRP) Injections?

PRP injections are a treatment that separates the platelets in a patient’s own blood and uses them to promote healing. A small sample of blood is collected and placed in a centrifuge, a machine that spins at high speeds to separate the platelet-rich plasma from the other components, like red and white blood cells. Guided by ultrasound imaging to ensure accuracy and precision, the concentrated PRP is then injected directed into the affected area. The entire procedure takes about an hour.

Post-injection care may mean avoiding certain movements or activities for a period of time to optimize the healing process and minimize potential side effects. It’s normal for the injection site to become inflamed and may be quite painful for one to three days following treatment. The swelling and soreness are part of the healing process, and patients should avoid taking anti-inflammatory medication like Aspirin or ibuprofen, which can make the injection less effective.

What conditions do PRP injections treat?

PRP injections are frequently used to treat musculoskeletal injuries and orthopedic conditions like tendonitis, ligament sprains, bursitis, and partial rotator cuff tears, and tennis elbow. The injections can also be used to reduce joint pain, stiffness, and inflammation caused by arthritis.

How long will it take for me to see improvement?

Because the bioactive substances in the platelet-rich plasma need time to stimulate tissue repair and cellular regeneration, it can take a few weeks to start noticing the effects of PRP injections. Patients with musculoskeletal injuries like tendonitis or ligament sprains may experience improved functionality and pain relief quicker than patients with more severe or chronic conditions. Factors like age, overall health, and adherence to post-injection instructions all influence the speed of the healing process. It’s crucial to follow your doctor’s recommendations to maximize treatment benefits.

We recently sat down for a Q&A with our Sports Medicine provider and PRP expert, Dr. Andrew McMahon.

Q: In your own words, how does this procedure benefit your patients?
A: Platelet-rich plasma (PRP) therapy uses injections of a concentration of a patient’s own platelets to accelerate the healing of injured tendons, ligaments, muscles and joints. In this way, PRP injections use each individual patient’s own healing system to improve musculoskeletal problems.

Q: Who is a good candidate for a PRP Injection?
A:

Patients with overall good health
Patients with mild to moderate arthritis, partial tears, or chronic wear and tear injuries
Patients with decreased function due to pain, stiffness, or lack of mobility
Failure with more conservative treatment methods

It’s important to note that while PRP injections are generally considered safe, they may not be suitable for everyone. The treatment can’t be used if the tendon is torn completely and though PRP injections can address symptoms of arthritis, they can’t reverse pre-existing damage. The treatment’s efficacy and appropriateness depend on the specific condition being treated and individual patient factors. It’s important to consult with a specialist to evaluate whether PRP injections are appropriate for your specific needs.

Q: Where do you perform this procedure?
In our Portsmouth, NH office only, some of the surgeons use it intraoperatively.

Q: Do you have a recent patient success story you can share?
A: Recently, I have had a lot of success with PRP treating knee arthritis. Peter S. is a 68-year old gentleman who is very active in tennis/pickleball and is an avid skier. His moderate arthritis has given him a lot of stiffness and some pain which resulted in him cutting back on these activities at times, affecting his happiness and mental health. He had a consult for treatment options and we ultimately opted to inject PRP into both knees. Within 4 weeks, he had regained a significant amount of his function and he was able to play more tennis, and he successfully took a week long ski trip to Colorado.

Q: Anything else you’d like current or future patients to know about this procedure and how it would benefit them?
A: In the appropriate patient, PRP can offer a nice treatment option for patients with musculoskeletal problems who have failed conservative treatment options like PT, bracing, and cortisone injections. PRP can help heal soft tissue injuries (a torn tendon, for example), potentially avoiding surgical repair. PRP also provides patients with arthritis a treatment option that decreases pain and increases mobility and function. It typically lasts 2-3 times longer than cortisone injections and does not contribute to deterioration of the joint like a cortisone injection can.

Think PRP Injections may be right for you? Schedule a consultation with our specialist Dr. McMahon to learn more.

What IS Pain Management?

Pain management providers see patients who are experiencing pain in the lower back, knee, head, hip, or neck, and who could be suffering from common conditions such as arthritis, fibromyalgia, migraines, sciatica, and much more. But what exactly is “pain management”?

We sat down with our board-certified interventional pain management provider, Dr. Andrew Lehn to ask him a few questions about his specialty: pain management.

Q. What is the most common reason patients come to see you?

A. I treat pain from head to toe but low back pain is the most common complaint. It is estimated that up to 80% of people will have significant low back pain at some point in their lives!

Q. What is pain management, in your professional opinion?

A. Pain management is restoration. Pain means something is not functioning correctly. My goal is to try and figure out the source of pain and direct treatment to that location. Some conditions require surgery to correct but many things can improve by decreasing inflammation and facilitating healing. My goal is to restore someone back to how they felt before the pain started.

Q. What advice would you give a friend or a loved one if they are experiencing back or joint pain?

A. Exercise! Most painful conditions will improve with time. The goal is to strengthen the muscles and joints around a painful area so hopefully the pain does not increase. I tell people to think about joint pain like you would think about your heart. Imagine what your cardiologist would tell you: exercise, lose weight, eat healthy, decrease stress, prioritize good sleep. All these things will help your pain as well.

Q. Can you share a patient success story?

A. Recently, I had an elderly patient who was experiencing significant low back and buttock pain. She was frustrated because she was having difficulty doing her exercises and could not participate in physical therapy. Her Lumbar MRI had some degenerative issues and spinal narrowing but nothing too specific for the pain she was experiencing. She had pain around her Sacroiliac joint and her pain worsened with manipulation of the joint. I decided to inject her SI joint and she came back with significant relief. While her pain was not entirely gone, she felt that she could now do her exercises and return to physical therapy. Ultimately, that is the goal! I work alongside my patients to help get them going again and then they are better able to rehabilitate their injury and get back to functioning again.

Pain management works best when the patient and doctor work together for the best solutions.

If you’re experiencing pain of any kind, talk to Dr. Lehn today to see how he can help you overcome your pain issues and get back to living a fuller, pain-free life.

Schedule a consultation HERE or give us a call, 603-431-1121.