Wednesday, April 23, 2014
Cortisone injections for old injuries?
Hi, I had an injury almost 4 years ago when I slipped on a slippery hotel floor not long after I arrived for work in Sth Korea. I went back home to Australia for treatment, though not a lot happened. Basically I slipped, my left knee `popped` out of joint (dislocated) and then immediately started to feel swollen. I wasn`t able to get to the doctor until the next day, when he took a syringe- full of blood from my knee (being swollen). Back in Australia I saw the orthopedic surgeon, who Xrayed me and also an MRI, but nothing at all was found. I also had some physio which helped very little. Since this I have only been able to go up stairs one at a time. Also, I`ve had anothe incident where I`m once again feeling `popping` and the stiffness is still there after all this time. I have recently tried about 8 treatments of acupuncture with little success. I`m going crazy- I`m now walking with a limb as I can`t bend while walking. There is no actual pain, just discomfort and stiffeness, close to the kneecap (and under). Someone suggested cortisone injections to me- could they work after all this time? At least enough to even work on it to walk up and down stairs normally again? I am only 30.
You mentioned at the time of your initial injury your knee "popped out of joint (dislocated)". This most likely refers to your patella (kneecap) having become dislocated, since it would be unusual for a complete knee dislocation (between the tibia - or shin bone - and femur - or thigh bone) to result from a slip on a floor, and the treatment for a complete knee dislocation is surgical.
Normal knee X-rays following a patellar dislocation are not unusual; this indicates no evident fractures nor arthritic changes. However, a "normal MRI" following a patellar dislocation is surprising... sometimes "normal" is a translation for "showed nothing requiring surgery." Alternatively or in addition, the quality of the images from your knee MRI scan may have been suboptimal, as may have occurred if your knee was not completely stationary during the scan.
If you've not undergone re-evaluation by your physician since your injury almost 4 years ago, you are strongly encouraged to do so, particularly given the extent to which your persisting symptoms continue to limit your activities. In particular, your physician should be able to determine whether you have:
· persisting patellar laxity or looseness (subluxation) - which could benefit from wearing a "patellar stabilization sleeve", an appropriate exercise program including strengthening exercises for your hip/"core" and ankle muscles - in addition to thigh muscles, or as a last resort, surgical stabilization;
· "post-traumatic arthritis"; and/or
· a knee condition in addition to what sounds like patellofemoral (kneecap) pain.
Although a physical examination may be sufficient to make these determinations, repeat/updated imaging studies may be considered also.
Regarding your question about cortisone (steroid) injections, if there's ongoing inflammation in your knee, a steroid injection should help, even after all this time, although the extent/duration of benefit is hard to predict.
Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University