Steroid injections

Why would I need a steroid injection into my TMJ?

If you have predominantly painful joints (arthralgia) with associated degenerative changes (arthritis) confirmed on imaging, then we may discuss a steroid injection as a treatment option. This is a very safe, simple and effective outpatient intervention. For most patients with arthritis, I will recommend an arthroscopy with a possible view to open arthroplasty and/or total joint replacement if sufficient criteria are met and there is no response to minimally invasive surgery. I recognise however, that I do not treat “conditions”, but rather patients. I am mindful that some patients would like to keep things as simple as possible, stay outside the operating theatre and trial outpatient-based treatments. Whilst the effectiveness of steroid injections is likely to be less when compared with arthroscopy/arthrocentesis and/or open surgery, in some the responses can be fantastic with significant improvements in pain and quality of life.

How is it administered?

I tend to use DepoMedrone® in my practice. The treatment takes place at an outpatient appointment, usually 15 minutes are all that is required including paperwork. We will start by completing a written consent form and answering any queries you may have. The DepoMedrone® is reconstituted (mixed up) with a long-acting local anaesthetic (0.25% bupivacaine). Using a very careful aseptic technique, I will palpate your joint and after giving some superficial local anaesthetic to numb the area, will provide the deeper injection into the joint itself. I have a deep understanding of the anatomy of this area from a combination of my long surgical training and regular practice in minimally invasive and open surgical techniques to the joint, translating to high levels of accuracy in localising the small joint space that can be seen in arthritic TMJs.

Are there any risks?

Yes, despite being minimally invasive, there are still risks, although these re exceedingly uncommon. I usually warn people about risks of pain, swelling, bleeding, infection (including a rare complication known as septic arthritis), a transient disturbance in the occlusion (bite), temporary facial paralysis and failure to improve symptoms. Because of the risk of facial weakness (lasting a few hours), I will ask that you are accompanied to this appointment by someone who can drive you home afterwards. In addition, there is a risk of accelerating degenerative changes of the joint (in essence trading symptom relief for degeneration). This is a risk deduced from the literature in orthopaedics, but steroid injections are commonly practice, incredibly beneficial in the right patient and only administered to those patients who have already established arthritis (end stage disease) and decline more advanced surgical options.