Ideally I need these injections every three months. My last treatment was on May 12 -- that's more than four months ago. I've been really suffering recently, but once the steroid wears off... Yeah, you got it!
Here we go!
What is a bursal injection?
To understand the injection, you have to know what a bursa is: the soft tissue space between two structures (such as bone, muscle, tendon and skin) which allows the structures to slide over one another. (Soft tissue, such as muscle, fat and skin, connects and surrounds the bones and internal organs of the body.)
Bursas that get injections include:
Shoulder: subacromial bursa
Hip: trochanteric submaximus bursa
Elbow: olecranon bursa
Knee: prepatellar bursa
In some cases these injections are done in combination with an ultrasound that's used to guide the placement of a needle directly into the bursa.
My primary caregiver (a nurse practitioner with her Master's degree) performs my injections without an ultrasound. (This is actually common, by the way. I know several people who get this injections without ultrasounds.) She uses FOUR syringes. These are the normal 'cocktail' of one injection of local anaesthetic medication, and a second injection of corticosteroid ('cortisone' or 'steroid'). The local anaesthetic is not merely used to numb the site, it's actually a part of the treatment, helping the inflammation that's being treated.
Bursitis (inflammation of a bursa) is a common cause of soft tissue pain. Movement of the affected area becomes painful and one can also experience reduced movement. The injection of a small dose of local anaesthetic and corticosteroid into the bursa might relieve these symptoms by reducing inflammation in or around the bursa. Bursitis around the hip is usually over the lateral aspect (outside) of the hip, where the gluteal muscles are located. These muscles lie within your buttock, and extend to the top and outside of the upper femur (leg bone). You are more likely to feel focal tenderness (pain when pressing) over the bone on the outside of the hip, and pain can sometimes go down the outside of your thigh. Lateral hip bursitis can also give a person pain at night and disturb your sleep.
My PC has me simply pull down my pants and lie on the exam table on my side. She probes to find the exact location then using the first syringe to inject, followed shortly after by the second injection. When that's done, we repeat the process on the second hip. The needles are longer than usually used for injections in the arm. But the process is very quick -- it only takes a few minutes.
Today my PC told me she, too, was having a flareup. We discussed how the change in the weather can affect flareups (I'm often worse in Autumn).
After this procedure you're supposed to rest the injected body part for a minimum of six hours, then limit use for a minimum of three days to a week. As with any injection, there is sometimes a dull ache for a few hours after the procedure. There might be an area of numbness around the injection site, for 1 or 2 hours, due to the local anaesthetic. Some bruising and a few spots of blood at the site of the injection might occur.
The corticosteroid does not usually start working for 24 hours, and sometimes this takes up to 3 days. During this time, the normal symptoms can continue or even worsen. Sometimes people can experience general reactions, such as flushing and redness of the body and face, related to the absorption of the corticosteroid into the body. These occur over the first few days. In diabetics, the absorption of the corticosteroid can increase the blood sugar levels (BSL) for a few days and the BSL should generally be checked several hours after the procedure.
This is a very safe procedure with few significant risks. (Few people complain of side-effects.)
The most common complaint is a temporary worsening of the symptoms over 1, 2 or even 3 days. There is a very small risk of infection, which is minimized by the doctor carrying out the procedure in clean conditions. There is a very small risk of damage to the soft tissues at the injection site. This is called tissue atrophy, which is a thinning or scarring of the skin or subcutaneous fat (fat found just beneath the skin), and can occur when the injected medication is very close to the surface. Tissue atrophy can also affect deeper structures in the body. This is more likely with repeated injections at the same location. Some people find that the injection gives them pain relief for a few months, but then the pain comes back and they wonder about the safety of having another injection. Although the exact risk of multiple injections is not known, most doctors would advise against having a bursal injection more than three to four times a year to avoid tissue atrophy. This is more important when the injection is carried out in areas where there is already significant wear or tear (partly torn tendons or ligaments).
What are the benefits of a bursal injection?
The aim of a bursal injection is primarily to reduce any inflammation in or around the bursa by injecting a small dose of corticosteroid and local anaesthetic. This should result in pain relief and swelling reduction.
I'm NOT KIDDING when I say that these bursal injections are like a miracle for me! They really help with the pain.
I have to do several things to avoid flareups, which include not exposing my joints to the cold during autumn and winter months. Sometimes overuse of my joints can also cause a flareup.
There are side effects from these injections:
High blood pressure
Increased appetite (weight gain)
Increased growth of body hair
Lower resistance to infection
Nervousness and/or restlessness
Sudden mood swings
Swollen puffy face
Water retention (swelling)
Worsening of diabetes (higher blood sugar)
I've noticed higher blood sugar after these shots (but it normally doesn't last that long). And restlessness and insomnia. Most recently I noticed water retention, too. It can make me either thirsty or hungry or both.
Our cat Henry is on steroids every single day (oral pills). One of the things we're trying to do is increase his weight, so it works really well for that! He's very healthy with this medication...
I'm looking forward to far less pain by the end of next week!