As a doctor of chiropractic, you know how to address joint pain without the use of drugs, but unfortunately, corticosteroid injections remain a popular choice among medical providers for patients suffering from osteoarthritis. The problem, according to new research: such injections may actually escalate the progression of OA and increase the likelihood that the patient will require joint replacement surgery at some point.
Published in Radiology, "Intra-articular Corticosteroid Injections in the Hip and Knee: Perhaps Not as Safe as We Thought?" by A.J. Kompel, et al., found a significant rate of complications among osteoarthritis patients who received intra-articular corticosteroid injections to the hips or knees. Complications appeared two to 15 months following the injections.
Findings came courtesy of analysis of two sources: the existing literature database on corticosteroid injections for OA and data on 459 patients at Boston Medical Center who received 1-3 injections for hip or knee OA in 2018.
The clinical takeaway, according to the study: "In patients with no OA or only mild OA on a radiograph who are referred for IACS injection to treat joint pain, the indication for IACS injection should be closely scrutinized. Case series and retrospective reviews have shown that some patients who develop rapid progressive joint space loss or destructive OA tend to have no OA or only mild OA at initial presentation."
In their introduction, the researchers emphasize that "practitioners should be alert for emerging evidence that clarifies or helps determine the balance between benefits and potential harm. Patient preference should have a substantial influence on the type of treatment selected." If their very own study isn't "emerging evidence that helps clarify" the potential harm side of the equation, we don't know what does. Make sure your OA patients understand these findings and are well-educated on nondrug alternatives for their joint pain.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
Some pundits say that the upcoming presidential and congressional races, and many local races, might be the most consequential in our country’s history. We do not have the choice of sitting on the sidelines and hoping our patients will carry our water. Unlike other medical professions such as physical therapists, podiatrists, nurses, etc., the health care class (AMA) will not protect us. We must be in the game.
The most common condition affecting the shoulder is rotator-cuff disease. From acute tears to chronic tendinopathy, it’s common and needs a thorough workup. In fact, even asymptomatic shoulders can have full-thickness rotator-cuff rears in up to 40% of instances. Let’s look at additional conditions that can present to the office with weakness, loss of motion and pain in the shoulder beyond rotator-cuff tears.
