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.
The proposed merger of the National Board of Chiropractic Examiners and Federation of Chiropractic Licensing Boards was approved by NBCE delegates and FCLB members at their respective annual meetings, held jointly in Atlanta, Ga., this year. Per the new bylaws, the new entity takes the NBCE name, with FCLB continuing as a department within NBCE. The federation will continue to enjoy Board of Directors representation on what will be a single, expanded board.
Before introducing subscapularis syndrome as an upper extremity analog, it is essential to revisit piriformis syndrome as a well-established example of myogenic pseudo-radiculopathy. Piriformis syndrome has long served as a clinical exception to disc-centric models of lower extremity pain and provides an important framework for understanding how deep muscular dysfunction can mimic radiculopathy in the absence of nerve root compression.
Pain has become the dominant language of musculoskeletal healthcare. Numeric pain-rating scales and symptom reports are routinely used as primary indicators of clinical success. But while pain reduction is meaningful, it is an incomplete and often misleading representation of recovery. This has real consequences for patient adherence, long-term outcomes, and how conservative care is perceived within the broader healthcare system.
