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    Intra-Articular Corticosteroid Injection

Intra-Articular Corticosteroid Injection

If you are in a great deal of pain from synovitis and regular non-steroidal anti-inflammatory drugs like aspirin or ibuprofen are ineffective, your physician may opt to give you an intra-articular corticosteroid injection directly into your knee. Corticosteroids are usually injected from the side of the knee into the center of the joint. Many physicians can administer the shots, but they are typically performed in a hospital or in your orthopedist's or rheumatologist's office. It is important to be aware of the potentially dangerous side effects of corticosteroid injections. As with any type of injection into a joint, there is the risk of infection. In addition, in high or repetitive doses, corticosteroids may actually destroy the knee's articular cartilage and tendons. Cortisone shots should be taken sparingly, no more than one every six months. If your need for corticosteroid shots increases rather than decreases, you probably need to seek treatment for the underlying knee problem that is causing synovitis. Intra-articular corticosteroid shots should never be used on children or teenagers unless they suffer from an inflammatory arthritis and are being closely monitored by a rheumatologist.

Steroid shots can take anywhere from two weeks to six months to provide enough pain relief from synovitis to begin strengthening exercises in rehabilitation. The underlying cause of synovitis, whether it was arthritis, torn cartilage, or other knee problems, usually dictates the specific rehab program you need to undergo. In the absence of complications, your physician may prescribe visits to a physical therapist to begin supervised strengthening exercises as soon as your pain and swelling go away. Total rehabilitation after synovitis takes between three to six months, but most people can return to activities as soon as they are able, which is usually within three to six weeks. After synovitis, you usually need to avoid strenuous activities that put pressure on the bones in your knee. Running, jumping, or twisting may aggravate the synovial membrane and increase its production of fluid, possibly causing your knee to swell up again. Your physician and physical therapist can design a custom rehab program to address your needs. In general, the rehab program to help heal your knee after synovitis follows a pattern. Rehab progresses from stretching exercises to strengthening exercises that focus on the quadriceps and hamstrings ­ the main stabilizing muscles for your knee. Physicians suggest you gradually increase the amount of weight as your leg muscles get stronger. Strengthening exercises require dedication because results often take weeks and pain may recur. After about three months of rehab, physical therapy usually can become activity-oriented as you regain the ability to perform complicated movements, using stationary bikes, elliptical machines, and cross-country skiing machines. Physicians typically suggest that you continue strength training even after synovitis has healed. Have your physician periodically check your knee for strength and proper function.

The best way to prevent recurring synovitis is to properly treat the knee problem or disease that caused synovitis. You may be able to reduce your chances of recurring synovitis by avoiding a sudden increase in activities that require repetitive motion, such as cycling or using a stair-climbing machine. Easing into an exercise routine after synovitis can help reduce stress on the synovial membrane and help you avoid irritation. In the absence of other knee complications, the amount of caution you should use during activities to prevent synovitis from recurring depends on your age as follows:

   Children - Synovitis usually does not hinder joint function after an injury. Once synovitis heals, it rarely returns.

   Adults - Synovitis may signal that you have sustained some degree of cartilage damage. Becoming less involved in strenuous activities, like contact sports or long distance running, may help prevent future synovitis. But you do not need to avoid activities or be overly concerned with prevention unless the underlying cause of your synovitis was a severe disease or injury that warrants extra prevention measures.

   Seniors - Synovitis may be more problematic later in life, harming the function of your knee joint, and you should continue to visit your physician for check-ups after your knee heals. Because synovitis is a common companion of rheumatoid arthritis and osteoarthritis, you should strongly consider cutting back your activity level to avoid situations that could strain your knee joint.

Weight control is also important. One extra pound of body weight translates into three or four pounds of weight across your knee every time you take a step. Lightening the load on your knees helps them to function better. Your physician may prescribe a lightweight knee brace to wear during sports that require side-to-side or twisting motions. You should also consider wearing kneepads during activities like in-line skating that put you at risk for falling.