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Intra-Articular Corticosteroid Injection
Intra-Articular Corticosteroid Injection
If you are in a great deal of
pain from synovitis and regular non-steroidal anti-inflammatory
drugs like aspirin or ibuprofen are ineffective, your
physician may opt to give you an intra-articular corticosteroid
injection directly into your knee. Corticosteroids are
usually injected from the side of the knee into the
center of the joint. Many physicians can administer
the shots, but they are typically performed in a hospital
or in your orthopedist's or rheumatologist's
office. It is important to be aware of the potentially
dangerous side effects of corticosteroid injections.
As with any type of injection into a joint, there is
the risk of infection. In addition, in high or repetitive
doses, corticosteroids may actually destroy the knee's
articular cartilage and tendons. Cortisone shots should
be taken sparingly, no more than one every six months.
If your need for corticosteroid shots increases rather
than decreases, you probably need to seek treatment
for the underlying knee problem that is causing synovitis.
Intra-articular corticosteroid shots should never be
used on children or teenagers unless they suffer from
an inflammatory arthritis and are being closely monitored
by a rheumatologist.
Steroid shots can take anywhere from two weeks to six
months to provide enough pain relief from synovitis
to begin strengthening exercises in rehabilitation.
The underlying cause of synovitis, whether it was arthritis,
torn cartilage, or other knee problems, usually dictates
the specific rehab program you need to undergo. In the
absence of complications, your physician may prescribe
visits to a physical therapist to begin supervised strengthening
exercises as soon as your pain and swelling go away.
Total rehabilitation after synovitis takes between three
to six months, but most people can return to activities
as soon as they are able, which is usually within three
to six weeks. After synovitis, you usually need to avoid
strenuous activities that put pressure on the bones
in your knee. Running, jumping, or twisting may aggravate
the synovial membrane and increase its production of
fluid, possibly causing your knee to swell up again.
Your physician and physical therapist can design a custom
rehab program to address your needs. In general, the
rehab program to help heal your knee after synovitis
follows a pattern. Rehab progresses from stretching
exercises to strengthening exercises that focus on the
quadriceps and hamstrings the main stabilizing
muscles for your knee. Physicians suggest you gradually
increase the amount of weight as your leg muscles get
stronger. Strengthening exercises require dedication
because results often take weeks and pain may recur.
After about three months of rehab, physical therapy
usually can become activity-oriented as you regain the
ability to perform complicated movements, using stationary
bikes, elliptical machines, and cross-country skiing
machines. Physicians typically suggest that you continue
strength training even after synovitis has healed. Have
your physician periodically check your knee for strength
and proper function.
The best way to prevent recurring synovitis is to properly
treat the knee problem or disease that caused synovitis.
You may be able to reduce your chances of recurring
synovitis by avoiding a sudden increase in activities
that require repetitive motion, such as cycling or using
a stair-climbing machine. Easing into an exercise routine
after synovitis can help reduce stress on the synovial
membrane and help you avoid irritation. In the absence
of other knee complications, the amount of caution you
should use during activities to prevent synovitis from
recurring depends on your age as follows:
- Synovitis usually does not hinder joint function after
an injury. Once synovitis heals, it rarely returns.
- Synovitis may signal that you have sustained some
degree of cartilage damage. Becoming less involved in
strenuous activities, like contact sports or long distance
running, may help prevent future synovitis. But you
do not need to avoid activities or be overly concerned
with prevention unless the underlying cause of your
synovitis was a severe disease or injury that warrants
extra prevention measures.
- Synovitis may be more problematic later in life, harming
the function of your knee joint, and you should continue
to visit your physician for check-ups after your knee
heals. Because synovitis is a common companion of rheumatoid
arthritis and osteoarthritis, you should strongly consider
cutting back your activity level to avoid situations
that could strain your knee joint.
Weight control is also important. One extra pound of
body weight translates into three or four pounds of
weight across your knee every time you take a step.
Lightening the load on your knees helps them to function
better. Your physician may prescribe a lightweight knee
brace to wear during sports that require side-to-side
or twisting motions. You should also consider wearing
kneepads during activities like in-line skating that
put you at risk for falling.