Shoulder elbow and hand orthopaedic conditions are some of the commonest
presentations to the general orthopaedic surgeon. The initial treatment for many such
conditions involves oral anti-inflammatory medications, bracing and physiotherapy failing
which a local steroid injection is next least invasive treatment to avoid surgery. Pradeep
Balasubramanian, Dubai, explores some of the most common conditions requiring
steroid injections in the upper limb and how it is safe and effective to treat them even
during the covid era.
Pradeep Balasubramanian Dubai explains that there are many upper limb conditions
that may respond to steroid injections. Many people are apprehensive about any
invasive procedures. Much of this fear is generated by anecdotes of complications or
poor outcomes. Dr Bala urges anyone who is recommended a steroid injection to read
this blog to be aware of benefits and risks involved in this simple outpatient procedure.
He can also share consented videos of such procedures prior to having one.
Some of the most common conditions where a steroid injection may benefit conditions of
the upper limb include a shoulder joint steroid injection for Frozen shoulder, a
subacromial steroid injection for shoulder impingement, an biceps groove injection in the
front of the shoulder for bicipital tendinitis, injection of the outer elbow for tennis elbow,
injection of the outer side of the wrist for Dequervains Tenosynovitis, injection of the
fingers at the A1 pulley for trigger finger or injection of the centre of the wrist on the
palmar side for carpal tunnel syndrome. Other less common conditions where steroid
injections maybe beneficial are injections into the wrist joint at the back of the wrist for
early arthritis, minor ligament tears and instability, injection into the elbow joint for elbow
arthritis, on the inside of the elbow for golfers elbow, behind the elbow for posterior
elbow impingement and injection of the AC joint of the shoulder for ACJ arthrosis.
Although in theory steroid injections carry a theoretical risk of infection, steroid flare and
hypopigmentation of the skin above the site of the injection Dr Bala has not seen many
of this in his decade and a half of orthopaedic practice. A steroid flare is a worsening of
the pain after the steroid injection usually due to the steroid causing an initial
inflammatory process in the soft tissue. Hypopigmentation is a fairly common side effect
especially in the brown or yellow skinned population and less obvious in the whiter
races.
An infection is very rare and almost never occurs if the appropriate aseptic precautions
are taken. In the unlikely event it should happen Dr Bala is well versed in managing this.
It is always a good idea to postpone injections in patients with uncontrolled diabetes until
the diabetes can be controlled well acutely with insulin if required. In-fact the commonest
condition in diabetics requiring a steroid injection is a frozen shoulder
There are very rare complications of a steroid injection in the upper limb which may
include a vasovagal response, collapse and seizures which maybe triggered by
apprehension to the procedure especially in young and fit males. These maybe avoided
by adequate education prior to the procedure and adequate backup for resuscitation
should it ever be required.
Although systemic steroids have systemic side effects such as immunosuppression or
growth disturbance in children, a locally injected steroid almost never has any such
systemic side effects. It is therefore very safe to have even during this covid era.
Steroids must also be avoided if possible into a joint with suspected monoarthritis until a
definitive biopsy has been taken to confirm the diagnosis.
According to Pradeep Balasubramanian Dubai, a shoulder, elbow, and hand surgeon in
Dubai, United Arab Emirates, most people are prone to some upper limb injury or
condition in their lifetime. Pradeep Balasubramanian of Dubai identifies that these
problems may require specialist attention.
After spending over a decade and a half with patients who have suffered from upper
limb conditions, Pradeep Balasubramanian Dubai will offer the best possible treatment
individualized to every persons needs. He understands how steroid injections maybe a
quickfix to avoid surgery and get you back to being active again with the least morbidity.
He can recommend ways around how to get approval for steroid injections to treat your
shoulder elbow and hand condition. More pictures, videos and youtube links are
available on www.pradeepbala.com outlining injections to address common conditions
of the upper limb.
A mindset change is the need of the hour to accept steroid injection more readily. Health
is happiness and Dubai is aiming to be the happiest city in the world to live in. After all
there are some things money can’t buy, and orthopaedic upper limb health is one of
them!
More About Pradeep Balasubramanian
Pradeep Balasubramanian Dubai is a globally trained shoulder, elbow, and hand
surgeon. He attended university in India and has completed three fellowships including 2
in Australia. He currently works as a visiting Shoulder Elbow and Hand surgeon in UAE.
