Cortisone injections

[art.chick]

I have heard some bad things about cortisone injections in joints. What are some risks (diving-related if known) of an epidural injection to the lower cervical vertibrae? Are there alternatives to treat "small bumps" on the cartiledge rings?

 

[DocVikingo]

Hi art.chick,

Such injections commonly contain both cortisone & a local anaesthetic. The local anaesthetic provides some direct pain relief but is temporary. The cortisone works longer-term to reduce inflammation. Do be aware that these injections can fail to relieve signs & symptoms as they can be expected to benefit only those resulting from inflammation. Other sources of pain may not be effected.

Given a properly & carefully administered injection, generally risks are quite low. Among things that can go wrong are infection, bleeding, including that which can cause a hematoma that presses on nerves, and mechanical damage to nerve roots contacted by the needle.

Of course, repeated injections into a joint increase the likelihood of such adverse events, and carry the additional risk that cortisone may eventually soften the cartilage between bony structures and worsen discomfort.

The risks that cervical spinal disorder may pose for scuba & vice-versa must also be assessed. For example, pain that distracts the diver, restricted range of motion or other troubling aspects must be carefully considered. Diving can also place substantial stress on the vertebral column. Although the cervical area seems less at risk than lower regions such as the lumbar spine, it nonetheless appears prudent to protect the neck from additional damage.

I am not aware of any studies on such injection & scuba. Beyond the theoretical possibility that it could mask some features of DCI in the cervical area, it would appear that if none of the above discussed potential problems were in play the treatment would not pose any direct threat.

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such. Your physician should be in the best position to advise on your fitness to dive.

Get better fast.

DocVikingo

 

[globaldiver]

Cortisone is known to break down connective tissue if directly injected into tendons (which are made of connective tissue). If a direct injection is made to treat an inflammation/tendinitis, you should not stress the tendon for about 2-3 weeks. If you go out and do heavy work, like diving and carrying heavy equipment, there is an increased risk of a bigger (partial or complete) tear of the treated tendon, and you end up with a bigger problem than you started with.

Many people think that the problem is gone when the pain is gone, and this is not always the case.

Sincerely

Anders

 

[DocVikingo]

Hi globaldiver,

Cortisone is known to weaken connective tissue of most sorts if directly injected, especially if repeatedly injected, although it sounds to me like art.chick's problem is related to an abnormality of articular cartilage rather than outlying supporting tendons.

It is true that reduction or abolishment of pain does not necessarily mean that the basic problem has been corrected.

Best regards.

DocVikingo

 

[art.chick]

No implied patient-doctor relationship is inferred; just appreciate the information. The injections that are being (potentially) suggested are in an effort to quickly wrap up a workman's comp case that seemed to involve primarily my hand, elbow, & shoulder. As treatments have progressed, other areas have shown improvement, & the neck is standing out as the remaining pain. After 8 months of suffering, it was deemed advisible to do an MRI. It showed "small bumps" on the cariledge & may or may not explain the pain.

I am under pressure from the state office of disability to move toward more aggressive treatment or concede that I need job retraining that will allow me to be productive although I have chosen to live with pain indefinitely. The orthopaedist on the case said that the next step would be cortisone injections, & if that fails, surgery. I hope to investigate other possible treatments. I have no clue where to start my search. Although everyone else would like to see this case closed quickly, it is still my body & I need more information before jumping on a treatment that I may regret & which may not solve the problem.

As I am uninsured right now, I feel like I am at the mercy of the crew that works with my attorney unless I do my own research. "Will she still be able to dive" will not likely be one of the criteria weighed by the practicioners who keep teling me, "But it's your decision." That's like telling a blind person that it's a matter of their personal taste if they want to wear yellow plaid with lavender seersucker; how would they know what "decision" they are making? Thanks for your input. I, too hope I am better soon.

 

[DocVikingo]

Hi art.chick,

Sounds like a somewhat complicated affair, both medically & administratively.

If this were my neck, I'd make all reasonable efforts at resisting being rushed into anything. In the absence of solid medical reasons for rapidly instituting more extreme procedures, first exhausting more conservative measures is generally wise. I worked for several years as psychiatric liaison to the pain treatment center of a world renowned university teaching hospital. While spinal surgery can bring relief where other treatments have failed, it is not without possible complications. The incidence of pain secondary to adhesions (troublesome scar tissue formation) is higher than many seem to realize, and can be very difficult to remedy.

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.


Best of luck.

DocVikingo