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Cortisone and Viscosupplement Injections

Viscosupplements are materials, which can be injected into an arthritic and usually dysfunctional joint virtually in a part of the body that was accessible to needle.  They are composed of a material known as Hyaluronic Acid (HA) which occurs naturally in the body and this found in the synovial fluid inside of joints and in the skin, etc. There are various kinds of Viscosupplements on the market and go by names such as Durolane, Hyalgan, Euflexa, Neovisc, Synvisc etc. Some are injected three or more times and others once.  They vary in their viscosity and ease of injection. It is difficult to predict how any individual will respond but in cases of mild to moderate arthritis, experience using them has been very positive and generally speaking, an average duration of benefit is somewhere between 6 or so months. As a foreign, unnatural material is not being injected into the joint it is safe to repeat as needed.

The effect of the viscous supplement injection is to increase the amount of HA in the synovial fluid inside the joint, which effectively increases the ability of the joint to withstand shock and stress, which in turn improves function and reduces pain.

Occasionally reactions do occur and often involve a slight increase in pain or swelling and increased inflammation of the joint. This will generally resolve after 2 or 3 days, but may require icing or anti-inflammatory medication.

 Cortisone on the other hand belongs to a class of drugs known as steroids.  Steroids occur naturally in the body and are produced by the adrenal gland and perform numerous physiological roles.  Cortisone is a generic term, which covers various steroid medications such as Kenalog, Depo-Medrol etc. Different types of steroids exist and some such as the group known as anabolic steroids often taken illegally by bodybuilders and athletes, the effect of which is to increase her body mass. This is definitely not endorsed in this office.  The steroid used predominantly in Kinetics is Kenalog and it is not an anabolic steroid.  Instead, it's main effect is that of decreasing and suppressing inflammation in an injured tissue.  It does this very effectively and is very useful in cases of tendinitis, arthritis, bursitis, etc.It may also be used to breakdown excessive scar and keloid tissue that has formed after an injury or surgery.

Most the time the use of a cortisone-type medication will provide effective pain relief.  However, it must be understood that cortisone does not heal an injured tissue but only suppresses the inflammation.  It may allow a period of pain free time for spontaneous recovery to occur.  It may sometimes need to be repeated and occasionally does not provide any relief whatsoever.  It is not possible to predict which individuals will have a positive response.  Failures may occur if the cortisone is not placed exactly in the area of injury or inflammation and unfortunately most doctors do not have x-ray eyes and cannot always see exactly where the needle is placed.  Experience, knowledge of anatomy, good diagnosis and tissue feel helps to the ensure accurate needle placement and usually gives a satisfactory result.

Cortisone does have side effects and these can be discussed by the Kinetics physician recommending treatment with this substance.