Steroid Injection

Steroid injections, also known as corticosteroid injections, are a common treatment for reducing inflammation and pain in various parts of the body. They are often used for joint pain, arthritis, and other inflammatory conditions. They are injected into the tendon, muscle, joint, tunnel or trigger points in different locations of the body. Not all areas of the body are ideal locations for injections to be done. 

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Common Locations of Steroid Injections:

• Shoulder

• Elbow

• Wrist

• Hip

• Knee

• Ankle

• Spine

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CPT Codes for Steroid Injections:

• Major Joint or Bursa (e.g., shoulder, hip, knee, subacromial bursa, greater trochanteric bursitis)

  • 20610: Major joint or bursa without ultrasound guidance

  • 20611: Major joint or bursa with ultrasound guidance

• Intermediate Joint or Bursa (e.g., wrist, elbow, ankle, acromioclavicular)

  • 20605: Intermediate joint or bursa without ultrasound guidance

  • 20606: Intermediate joint or bursa with ultrasound guidance

• Small Joint or Bursa (e.g., fingers, toes)

  • 20600: Small joint or bursa without ultrasound guidance

  • 20604: Small joint or bursa with ultrasound guidance

• Trigger Points

  • 20552: Injection(s); single or multiple trigger point(s), one or two muscle(s)

  • 20553: Injection(s); single or multiple trigger point(s), three or more muscles

• Tendon Origins and Tendon Sheaths

  • 20550: Injection(s); single tendon sheath, or ligament, aponeurosis (e.g., plantar "fascia")

  • 20551: Injection(s); single tendon origin/insertion

• Carpal Tunnel

  • 20526: Injection, therapeutic (e.g., local anesthetic, corticosteroid), carpal tunnel

• Major Nerve Injection (e.g., sciatic, femoral)

  • 64415: Injection, anesthetic agent; brachial plexus, single

  • 64447: Injection, anesthetic agent; femoral nerve, single

  • 64450: Injection, anesthetic agent; other peripheral nerve or branch (radial tunnel)

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Post-Injection Recovery Experience:

After receiving a steroid injection, you may experience some side effects and a specific recovery process. Here's what to expect:

• Immediate Aftermath:

  • Some patients experience immediate relief, while others may notice improvement in 3 to 5 days.

  • It is common to feel a slight increase in pain or swelling in the area where the injection was administered. This typically subsides within 24 to 48 hours.

• Activity Restrictions:

  • Rest the injected area for at least 24 hours. Avoid strenuous activity or heavy lifting to allow the medication to take full effect.

  • Gradually resume normal activities as tolerated.

• Pain Management:

  • Over-the-counter pain relievers like acetaminophen or ibuprofen can help manage any discomfort post-injection.

  • Applying ice to the injection site can also reduce swelling and pain.

• Follow-Up Care:

  • Attend all scheduled follow-up appointments to monitor your progress and ensure the injection is effective.

  • Physical therapy may be recommended to enhance the benefits of the injection and improve the function of the affected area.

• Potential Side Effects:

  • Common side effects include temporary pain, swelling, and redness at the injection site.

  • Less common side effects may include facial flushing, insomnia, and high blood sugar levels, particularly in patients with diabetes.

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Risks and Side Effects for Diabetics Undergoing Steroid Injections:

Steroid injections are an effective treatment for inflammation and pain, but they can pose specific risks and side effects for diabetic patients. Understanding these risks is crucial for managing diabetes and ensuring overall health.

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Risks and Side Effects:

• Increased Blood Sugar Levels:

  • Short-Term Increase: Steroid injections can cause a temporary rise in blood sugar levels, lasting several days to a week.

  • Monitoring: It is important for diabetic patients to monitor their blood sugar levels more frequently following a steroid injection. Adjustments to diabetes medications may be necessary to manage this increase.

• Infection:

  • Risk: While rare, steroid injections can introduce bacteria into the injection site, leading to an infection.

  • Precautions: Ensuring the procedure is performed in a sterile environment and following post-injection care instructions can minimize this risk.

• Delayed Wound Healing:

  • Effect: Steroids can impair the body’s ability to heal wounds, which may be a concern for diabetic patients who already have slower healing rates.

  • Management: Proper wound care and close monitoring of the injection site for any signs of infection or delayed healing are essential.

• Skin and Soft Tissue Effects:

  • Thinning of the Skin: Steroid injections can cause thinning of the skin or subcutaneous fat at the injection site.

  • Depigmentation: There can be a loss of skin color in the area of the injection.

• Systemic Side Effects:

  • Increased Appetite and Weight Gain: Steroids can increase appetite, leading to potential weight gain, which can be challenging for diabetic patients.

  • Mood Changes: Some patients may experience mood swings, anxiety, or other psychological effects.

• Osteoporosis:

  • Bone Density Loss: Long-term or repeated use of steroids can lead to a decrease in bone density, increasing the risk of osteoporosis.

• Eye Problems:

  • Risk: Steroids can increase the risk of cataracts and glaucoma, which diabetic patients are already more susceptible to.

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Managing Risks for Diabetic Patients:

• Pre-Injection Consultation:

  • Discuss with your healthcare provider about your diabetes and the potential risks associated with steroid injections.

  • Ensure a comprehensive plan is in place to monitor and manage blood sugar levels.

• Blood Sugar Monitoring:

  • Increase the frequency of blood sugar testing following the injection.

  • Be vigilant for any signs of hyperglycemia (high blood sugar), such as increased thirst, frequent urination, fatigue, and blurred vision.

• Medication Adjustments:

  • Your doctor may adjust your diabetes medications temporarily to counteract the blood sugar-raising effects of the steroid injection.

• Hydration and Diet:

  • Maintain proper hydration and follow a balanced diet to help manage blood sugar levels.

  • Avoid high-sugar foods and monitor carbohydrate intake closely.

Conclusion:

Steroid injections are a valuable treatment option for managing pain and inflammation in various joints and soft tissues. By following the recommended recovery guidelines and attending follow-up appointments, patients can maximize the benefits of this treatment and return to their daily activities with reduced discomfort.

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