It was recently recommended, by a radiologist, that I consider an injection of cortisone into my hip joint; a hip bursa injection. The procedure would be done by the radiologist, using ultrasound guidance. This recommendation was for bursitis in my right hip, which started not long after I fell hard onto my right side last March.
That fall was so bad that I broke my wrist, and that Colles’ fracture then triggered a rare disease; Complex Regional Pain Syndrome (CRPS). This condition causes a host of different symptoms, including excruciating pain.
While the radiologist was evaluating me, he seemed quite surprised that I’d waited so long to do anything about the pain from the post-fall bursitis in my hip. After the evaluation, he asked me about that.
When I told him that I was dealing with CRPS since March, he sat back in his chair and looked a bit confused. I realized that he might still know this disease by its old name, Reflex Sympathetic Dystrophy (RSD). When I said that name, his eyes widened, just a bit. What a poker player would call a ‘tell’, I guess 😉
A look of understanding dawned on his face, as the radiologist simply said: “Now I understand”… At this point, I told him that my initial reaction, to his suggestion of a bursa injection, had been that I was really beginning to feel like a medical pin cushion!
Why? Well, to start, I’ve had several arthrographic distensions over the past few years. These were to treat adhesive capsulitis, also called frozen shoulder. I had adhesive capsulitis in both shoulders, luckily about 18 months apart rather than simultaneously!
Then, since being diagnosed with CRPS, I’ve had a series of six stellate ganglion blocks and then two Bier or IV blocks. All of these were done in the day surgery operating room of my local community hospital… eight invasive medical procedures, between the end of May and the end of July!
My background is in clinical or medical research ethics, so I’m used to reading articles in medical and scientific journals for work. Since being diagnosed with CRPS, at the end of May, I’ve been looking into this rare condition by reading articles these types of journals.
I told the radiologist that I recalled having read about something called secondary CRPS in a medical journal. Before consenting to the hip injection, I wanted to track it down and reread it. I’m glad I did, because this is what the authors had to say:
CONCLUSIONS: These result suggest that patients with a history of CRPS are more likely to develop secondary CRPS compared to the rates reported in the literature among the general population.”(1)
If I had gone ahead with hip bursa injection, it’s not certain that I would have developed CRPS in that area. But this disease is so difficult to deal with, just in my right hand and arm, that I’d never even consider a medical procedure that could trigger it elsewhere in my body; not unless it was medically imperative.
For bursitis, hip bursa injection is considered an optional or additional therapy. As you might imagine, I opted not to schedule the injection. What I did instead was to drop off a copy of this article for the radiologist, with a note to let him know that I’d decided against the procedure.
On that copy, I highlighted the following paragraph, for educational purposes:
Patients with a history of CRPS should be counselled that they may be at risk for developing secondary CRPS if they undergo surgery or sustain trauma to another extremity.”(1)
CRPS is a rare disease, about which very little is known. I’ve begun to realize that even physicians don’t know much about it, so I’m going to do whatever I can to raise awareness of the condition!
Reference:
(1) Satteson ES, Harbour PW, Koman LA, Smith BP, and Li Z. The risk of pain syndrome affecting a previously non-painful limb following trauma or surgery in patients with a history of complex regional pain syndrome. Scand J Pain. 2017 Jan;14:84-88. doi: 10.1016/j.sjpain.2016.10.005. Epub 2016 Nov 22. Accessed 15 Dec 2016. Web:
https://www.ncbi.nlm.nih.gov/m/pubmed/28850441/