Shoulder, elbow, and hand orthopedic conditions are some of the most common presentations to the general orthopedic surgeon. The initial treatment for many such conditions involves oral anti-inflammatory medications, bracing, and physiotherapy. If these measures fail, a local steroid injection is the next least invasive treatment to avoid surgery. Pradeep Balasubramanian, Dubai, explores some of the most common conditions requiring steroid injections in the upper limb and how it is safe and effective to treat them even during the COVID era.
Pradeep Balasubramanian, Dubai, explains that there are many upper limb conditions that may respond to steroid injections. Many people are apprehensive about any invasive procedures. Much of this fear is generated by anecdotes of complications or poor outcomes. Dr. Bala urges anyone who is recommended a steroid injection to read this blog to be aware of the benefits and risks involved in this simple outpatient procedure. He can also share consented videos of such procedures prior to having one.
Some of the most common conditions where a steroid injection may benefit conditions of the upper limb include a shoulder joint steroid injection for frozen shoulder, a subacromial steroid injection for shoulder impingement, a biceps groove injection in the front of the shoulder for bicipital tendinitis, an injection of the outer elbow for tennis elbow, injection of the outer side of the wrist for De Quervain’s tenosynovitis, injection of the fingers at the A1 pulley for trigger finger, or injection of the center of the wrist on the palmar side for carpal tunnel syndrome. Other less common conditions where steroid injections may be beneficial are injections into the wrist joint at the back of the wrist for early arthritis, minor ligament tears and instability, injection into the elbow joint for elbow arthritis, on the inside of the elbow for golfer’s elbow, behind the elbow for posterior elbow impingement, and injection of the AC joint of the shoulder for ACJ arthrosis.
Although in theory, steroid injections carry a theoretical risk of infection, steroid flare, and hypopigmentation of the skin above the site of the injection, Dr. Bala has not seen many of these in his decade and a half of orthopedic practice. A steroid flare is a worsening of the pain after the steroid injection, usually due to the steroid causing an initial inflammatory process in the soft tissue. Hypopigmentation is a fairly common side effect, especially in the brown or yellow-skinned population, and less obvious in the whiter races.
An infection is very rare and almost never occurs if the appropriate aseptic precautions are taken. In the unlikely event it should happen, Dr. Bala is well versed in managing this. It is always a good idea to postpone injections in patients with uncontrolled diabetes until the diabetes can be controlled well acutely with insulin if required. In fact, the most common condition in diabetics requiring a steroid injection is a frozen shoulder.
There are very rare complications of a steroid injection in the upper limb which may include a vasovagal response, collapse, and seizures which may be triggered by apprehension to the procedure, especially in young and fit males. These may be avoided by adequate education prior to the procedure and adequate backup for resuscitation should it ever be required.
Although systemic steroids have systemic side effects such as immunosuppression or growth disturbance in children, a locally injected steroid almost never has any such systemic side effects. It is therefore very safe to have even during this COVID era. Steroids must also be avoided if possible in a joint with suspected monoarthritis until a definitive biopsy has been taken to confirm the diagnosis. According to Pradeep Balasubramanian, a shoulder, elbow, and hand surgeon in Dubai, United Arab Emirates, most people are prone to some upper limb injury or condition in their lifetime. Pradeep Balasubramanian of Dubai identifies that these problems may require specialist attention.
After spending over a decade and a half with patients who have suffered from upper limb conditions, Pradeep Balasubramanian, Dubai, will offer the best possible treatment individualized to every person’s needs. He understands how steroid injections may be a quick fix to avoid surgery and get you back to being active again with the least morbidity. He can recommend ways around how to get approval for steroid injections to treat your shoulder, elbow, and hand condition. More pictures, videos, and YouTube links are available on [www.pradeepbala.com](http://www.pradeepbala.com) outlining injections to address common conditions of the upper limb.
A mindset change is the need of the hour to accept steroid injections more readily. Health is happiness and Dubai is aiming to be the happiest city in the world to live in. After all, there are some things money can’t buy, and orthopedic upper limb health is one of them!
More About Pradeep Balasubramanian
Pradeep Balasubramanian, Dubai, is a globally trained shoulder, elbow, and hand surgeon. He attended university in India and has completed three fellowships, including two in Australia. He currently works as a visiting shoulder, elbow, and hand surgeon in the UAE.
