Steroid injection

[tempusfugi]

I am coming up to year 3 of PMR journey and, at the moment, am on 9.5 mg of Pred. In that time, I have undergone 2 Carpal Tunnel Syndrome (CTS) operations and, as from Monday next 20 January am possibly going to have a steroid injection in my right knee.

Recently, I had an MRI scan on my knee which has shown 'near complete loss of articular cartilage' and 'a tear in the medial meniscus' along with arthritis in the knee. Unfortunately, this has affected my mobility in the last few months, such that I can't walk far and need a forearm crutch to do so.

Both the CTS and the knee problem have come about since starting Pred, so I believe them to be a side-effect of steroids. When I had the CTS operations (local), it never occured to me that perhaps I should increase the Pred but since reading posts on the forum, I wonder if I should do so before having the steroid injection or does one only need to do that before have a full anasthetic type op?

Would be grateful to have your thoughts please. Many thanks.

[DorsetLady PMRGCAuk volunteer]

if you are talking about a steroid injection straight into the knee then no problem.. I had a couple in my knee and shoulder whilst on low doses of Pred. The Pred just goes to the local area to help the pain there -and you should be advised to rest that joint for 24 hours afterward.

It ‘s a minor procedure that only takes a minute or two and hopefully will help. 😊

[tempusfugi in reply to DorsetLady]

Thanks so much, DL. You have given me confidence, just by sending me your reply. It IS an injection straight into the knee as I understand it. Hopefully, it will work. I know they don't always do so. My brother had one the other year and had no response at all so eventually had knee replacement.

Hope you're continuing to enjoy your time in New Zealand😎

[DorsetLady PMRGCAuk volunteer in reply to tempusfugi]

I had a few over the years -and most were quite successful but did require replacements eventually..

Yes am still enjoying myself thanks…

[tempusfugi in reply to DorsetLady]

I suppose, then, these injections are a kind of stop-gap before going the whole hog. If they work for a while, fine, but as you say eventually replacements may be necessary.

[DorsetLady PMRGCAuk volunteer in reply to tempusfugi]

For some certainly - depends how quickly the OA deteriorates. It’s a familial issue for me, and definitely had it in knee pre GCA. .. Think shoulder was made worse by GP diagnosing frozen shoulder instead of GCA so had 3 steroid shots before correct diagnosis - although MRI scan whilst having GCA did show AO issues.

On higher doses it was “contained”but as I got down to single figures and then off Pred, it became more of an issue… ended up having 3 replacements-knee 2018, hip [aggravated by opposite knee- no previous issues] 2019 and finally shoulder in 2020.

Fingers crossed and with a following wind hopefully won’t need any more surgery.

[tempusfugi in reply to DorsetLady]

Gosh! It's amazing what you and others on this forum have gone through. Makes my complaints seem minor in comparison. As we so often say, it's people like you, PROpro and other regulars on this site that continue to inspire others. Such an enormous help and resource.

[DorsetLady PMRGCAuk volunteer in reply to tempusfugi]

Well I was disgustingly healthy until I hit 63 (only visited hospital for 2 pregnancies & a hysterectomy) but packed a lot in between then and 73.. Hoping I can get a few more “free” years - and intending to make the most of them😊

[Bcol in reply to tempusfugi]

Very similar tale to DL, a few injections over the years which generally made some difference but when you get to bone on bone then replacement is the only option. Had my replacement nearly twenty five years ago, it was, and still is brilliant.

[tempusfugi in reply to Bcol]

Thanks, Bcol. Wow! your replacement has lasted well. Very good to hear. I will, of course, be speaking to the Consultant in more detail about the result of my MRI scan, but I have a feeling I might eventually have to go down the road of a replacement. In fact, I think I might already be at the point of bone on bone since the scan showed a near complete loss of cartilage, which as I understand it is a shock absorber. Time will tell, I suppose.🤔

[DorsetLady PMRGCAuk volunteer in reply to tempusfugi]

This gives some info on issue and treatments

chrisbaileyorthopaedics.com...

[lkcreedon in reply to DorsetLady]

Great info here. Thanks for sharing this.

[PMRpro Ambassador in reply to tempusfugi]

I think it might be worth enquiring about PRP (plasma rich plasma) injections - if there is enough cartilage left to have an effect. Where does moderate end and severe start???

[piglette]

I have had steroid injections in my knee and shoulder too and no problem except the one in my shoulder did not work!

[tempusfugi in reply to piglette]

Oh! sorry to hear that the shoulder injection didn't work, piglette. So have you still got pain then or did something else happen with your shoulder (ie like Dorset Lady)?

[piglette in reply to tempusfugi]

I think I had sprained my shoulder somehow and it actually slowly got better. It was a private doctor and he insisted that I had an injection in my shoulder.

[tempusfugi in reply to piglette]

Interesting because this is a private consultant who is advising the injection, which he will action. On this occasion Benenden, my insurers, are forking out!

[piglette in reply to tempusfugi]

In my case it was a private consultant too although he also worked for the NHS. He charged about two hundred pounds for the injection which I don't think I needed.

[tempusfugi in reply to piglette]

What a pain, piglette, literally🙄

[powerwalk]

Best of luck. Hope it helps. Im basically held together with steroid injections!! I hate it but its the way it is. Hope you get relief.

[tempusfugi in reply to powerwalk]

Thanks, powerwalk. I don't know why but I have a feeling the injection won't work for me. I guess I just have to hope it will but, since it did nothing for my brother, I think my brain is telling me it won't do anything for me. Doesn't necessarily apply, of course. Must be my state of mnd😔

[DorsetLady PMRGCAuk volunteer in reply to tempusfugi]

No it doesn’t - and much depends on the personal on the other end of syringe getting it in correct place.. 😳

[powerwalk in reply to tempusfugi]

Honestly, your brother could have another one and it could work better. They are that kind of thing! Fingers crossed for you. Im off this morning for epidural for my back, like a patchwork quilt!! Let us know how it goes.

[tempusfugi in reply to powerwalk]

Thanks, powerwalk. I hope the epidural went ok today. I had one of those 47 years ago when I gave birth to my son.🥰 You sound as though you've had a few of those if your back is like a patchwork quilt! Will keep you posted...

[PMRpro Ambassador]

The CTS is not due to the pred - it is due to inflammation compressing the median nerve in a tunnel in the forearm - pred can relieve that so while it may have been OK at higher doses of pred, it may not be now you are at a lower dose. The inflammation may be due to the PMR which would account for them occurring in tandem.

The knee is another matter, There are doctors who believe that pred contributes to the breakdown of the cartilage - but pred also relieves some of the pain of OA so again, it was less noticeable at higher doses.

Do hope the injection helps - my daughter has meniscus problems and has had a few PRP injections on the NHS (Platet-Rich Plasma) which she says has made the knee feel totally different and better. They are used for mild to moderate OA, maybe yours is too far advanced but could be worth asking about.

[tempusfugi]

Thanks, PMRpro, of course it makes sense that it's PMR inflammation that probably caused the CTS. I have a tendency nowadays to blame Pred for anything and everything! So thanks for putting me right there.

As regards the knee, I first noticed a problem back in 2019 and was told that I had a torn cartilage at the time, so that was 3 years before I was diagnosed with 'a sort of PMR'. So I guess that's been coming on for some time.

It's good that your daughter gets relief from her PRP injections. As I understand it, I would need to come off steroids 2/3 weeks before a PRP injection and remain off Pred for a few weeks afterwards. I obviously can't do that so presumably the Consultant won't offer it to me.

[Pixix]

I think I’ve had about 20 steroid injections now, & the effect varies. I only had one that failed & it was a guided injection in an operating theatre into my hip, lasted 48 hours! All others have lasted well, up to 4 months. I have to say you are right, the attitude that your brothers injection didn’t work so yours won’t is not good!! Go into it with positivity, & hope…& it should work well!

[tempusfugi in reply to Pixix]

I'll take your advice, Pixix, and think positively (I am a glass half empty person, I know, or so my friends tell me)! I didn't realise one could have so many steroid injections - all new to me, I guess.

[Pixix in reply to tempusfugi]

Good news!! That’s the spirit. I suffer from Polymyalgia Rheumatica, Fibromyalgia, Raynauds Syndrome, Osteoarthritis, Hypermobility, Essential Tremor, Asthma, Vertigo, Trochanteric Bursitis, Haemangioma - spinal, Sciatica, Orthostatic Hypertension, Blepharitis & macular Degeneration…so I have needed to have steroid injections to help some of them! There is a limit to how many injections you can have in a year…but they are one of the few things that help me fight the battles with it all so I look forward to receiving them!!

[tempusfugi in reply to Pixix]

Heavens, Pixix, that is some list! I am really sorry to hear that you're having to endure all those complaints/diseases/conditions. Must really limit your lifestyle, so I can understand why you're a fan of injections. Good to hear they help you keep fighting your battles.🙂

[Pixix in reply to tempusfugi]

Thanks, it’s very challenging: I just wanted to show you the reason why I’ve had lots of injections, you wouldn’t necessarily need so many! S x

[Tiggy70]

Hi, I have torn irreparable tendons in my right shoulder. I have had 2 steroid injections in the last 9 months which have helped with the pain considerably. I had minor side effects after the injections. Good luck 🌸

[tempusfugi in reply to Tiggy70]

Thanks for your comments, Tiggy70. Am glad to hear that the 2 steroid injections you've had have helped you.☺️

[Doraflora]

Hi Tempusfugi. I had a steroid injection in my knee a couple of weeks ago. It was three days before my knee returned to “more or less normal”. Unfortunately it didn’t last long and now it’s the same as it was originally. But obviously there’s no one size fits all.

I’m having blood tests done tomorrow & then seeing the consultant again in March, although I might try & see if I can bring it forward as I’m getting more pain in my knee.

I received a copy of his letter in the post today, but I’ve had to google everything to understand it in English🤣.

“The right knee X-ray from the 11th November 2024 showed some very early osteoarthritic changes but otherwise showed normal appearances.

The ultrasound scan of the right knee showed an effusion and baker cyst. There was suggestion of suprapatellar and infrapatellar bursitis.

The MRI scan of right knee on the 17th November 2024 showed grade 1/2 chondral changes on the medial femoral and tibial condyles. There was a tiny nondisplaced horizontal tear over the medial margin of the medial meniscus. There was full thickness chondral loss of weight-bearing of the lateral femoral and tibial condyles in keeping with Grade 4 chondral changes. There was a degenerative horizontal tear in the posterior horn of the lateral meniscus. Full thickness chondral loss is present in the patella femoral compartment involving the lateral patella facet with grade 4 chondral changes. There was a large suprapatellar joint effusion but no evidence of synovial thickening or erosions. There was a popliteal cyst measuring 3cm in height. The impression was the large suprapatellar joint effusion was most likely related to the underlying degenerative chondral changes”

It’ll be interesting to see what the consultant advises next. (I’m almost five years with PMR) but I have considered myself very fortunate compared to some of the lovely people on here.

Keep us updated on how you go Tempusfugi.

[PMRpro Ambassador in reply to Doraflora]

Without looking things up in detail - I think I might be hoping for a new knee!!

[Doraflora in reply to PMRpro]

Yep! Me too…..🤞