This has been a bad few years for traditional medicine concepts like steroid and anesthetic shots to help relieve pain. Numerous studies have shown that these shots are highly toxic to local tissues. Despite this, physicians continue to deliver millions of these shots per year to unsuspecting patients. Now a new study continues the trend, highlighting shoulder steroid injection side effects.
Steroid shots are given in the shoulder to help relieve pain. Most commonly a doctor will combine a long acting local anesthetic like Marcaine (Bupiviciane) and a steroid anti-inflammatory like depomedrol, triamcinalone, hydrocortisone, or dexamethasone. The issue is that while these shots can really help relive pain and swelling, they don’t last long and have serious side effects.
Numerous studies (including our own) have shown that local anesthetics like Marcaine are highly toxic to local cells and tissues, killing them dead quickly. In fact, the use of Marcaine after shoulder surgery was the subject of a class action law suit because the anesthetic was so efficient at destroying shoulder cartilage. The steroid used in these shots is no better, with studies also showing that it hurts local cells and tissues. In addition, when the two are combined, you can get a 1+1=3 synergistic effect, with the concoction being more toxic than either drug alone. In addition, other new research shows that when used to treat inflamed tendons, when the pain does return, it’s worse than before the steroid injection. This new recently published study focused squarely on shoulder steroid injection side effects.
The study looked at two doses of commonly used steroid, the normal dose often used by doctors in shoulder steroid injections and a low dose at 1/10 that amount. The researchers exposed these steroid drugs to shoulder tendon cells, the same kind that make up the rotator cuff tendons in the shoulder. They looked at the health of the cells and whether they were showing signs of premature death (apoptosis). In the lower than normally used dose of steroid, the cells were clearly hurt, but recovered in a few weeks. In the normally used steroid dose, the shoulder tendon cells were wiped out and never recovered. Even with the low dose steroid, when it was given a second time to the same cells that looked like they had recovered, the cells never recovered from the second hit. This obviously means that the cells were injured by the 1/10 dose, but that the researchers had a hard time measuring this on the first go around. Does this lab study translate into real tendon damage in real patients? Research that was published just this past March showed that it does, with shoulder surgery patients who received steroid shots having tendon cells of poorer health than patients who didn’t get the shots.
The upshot? Steroid injections are bad news. We have more than enough data now that these medications in their usual doses should never be injected into joints or tendons. If they have to be used for some reason, patients should be counseled that they are receiving a toxic substance and that it’s use will likely damage their tissues. Given the amount of research on the topic of toxic anesthetics and steroids and a warning from the major Orthopedics Association (AAOS), have these shots tipped the scale from standard of care to medical malpractice?