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The term inflammation is at times overused.  For sure if you have an inflammatory arthritis condition such as Rheumatoid arthritis, inflammation occurs systemically and in the joints.  This sort of inflammation needs to be treated aggressively.  But pain and inflammation that occurs in a osteoarthritic joint or tendinitis is a different animal all together.  In the case of “wear and tear” arthritis or tendinitis conditions such as rotator cuff tendinitis, while there may be mild inflammation present, it is not of the variety found in rheumatoid arthritis.  Fluid taken from a joint with rheumatoid arthritis shows an extremely high white blood cell count.  Fluid taken from a osteoarthritic joint may show minimally elevated white blood cells at most, indicating minimal inflammation.

With this in mind, should steroid injections be used in both scenarios? In the case of rheumatoid arthritis, a steroid injection will reduce a intensely inflammed joint. This can be an appropriate use of steroids. On the other hand, in a osteoarthritic joint or tendinitis, steroid injections are not the correct option.  Correcting any biomechanical dysfunction with physical therapy will help. In addition regenerative treatments make sense as well in these cases for long term improvement.  Short term, rather than super high dose steroid injections, using a combination of numbing medication, other anti-inflammatory medications such as traumeel, and possibly miniscule doses of steroids as well (on the order of at least 1000 times lower dosage than is usually used).  A recent study also showed that Platelet Rich Plasma injections can help as much as injectable ketorolac, an anti-inflammatory used for pain relief that has a number of troubling potential side effects including kidney failure and stomach bleeding.  Also note that high dose steroid injections have the potential to also degrade joint cartilage and damage tendons.  Using a safer and more efficacious treatment regimen for osteoarthritis and tendinitis is essential.

The most important take away from this discussion is to recognize that not all joint pain should be treated with steroid injections. Consider the other options.

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