Posted by Dr. Ed on 8/10/07 10:46 Poster's previous posts
There are a lot of variables such as the type of steroid used in the injection, placement of the injection, volume of fluid used, the size of the needle, injection technique.
Three broad categories of injectable catabolic steroids (AKA 'cortisone') include short, intermediate and long acting:
-short acting: eg. dexamethasone phosphate; strong anti-inflammatory action, short duration of action, little effect on fibrosis, does not cause atrophy of surrounding tissue
-intermediate acting: eg. betamethasone acetate; weaker anti-inflammatory action, intermediate acting, moderate effect on fibrosis, may cause atrophy of healthy tissue in proximity ot target tissue
-long acting: eg. triamcinolone acetonide; minimal anti-inflammatory action, long acting, poor solubility, strong effect on fibrosis, causes atrophy of healthy tissue in proximity to target tissue
The above may be combined in proportions to achieve a specific therapeutic effect by the practitioner. The nerve rests in a bed of fatty tissue which acts as a cushion and glide path. Overuse of long acting and possibly intermediate acting steroids can atrophy that tissue allowing the nerve to become bound down.
The action (trauma) of puncturing the laciniate ligament (structure which holds the nerve) repeatedly with injections can create fibrosis and potential injury.
Hyaluronidase is the enzyme responsible for breakdown of scar tissue. It can be used alone or in conjunction with the above to enhance reduction of fibrosis. Hyaluronidase targets scar tissue (fibrosis) without causing atrophy of surrounding tissue.
Dr. Ed
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