Are Cortisone Injections Bad for You?

Cortisone injections are among the most commonly used treatments in orthopedics. Cortisone is a powerful anti-inflammatory medication that reduces the inflammatory response of many painful conditions. Cortisone is effective for different types of arthritis, tendonitis, and bursitis, among other conditions.

Uses

Cortisone can be used for a variety of orthopedic and rheumatological problems. The medication works by decreasing inflammation. Anti-inflammatory medications can be taken orally, but doing so distributes the medication in very small doses throughout the entire body.

A cortisone injection, on the other hand, places a large, powerful dose directly at the location of the inflammation. Therefore, the medication acts very powerfully against the problem. Furthermore, systemic side effects of a local cortisone injection are uncommon.

Because of the strong, quick effects of cortisone injections, they are often recommended for a variety of orthopedic problems. Among the most frequently treated conditions using cortisone injections are:

• Shoulder bursitis/rotator cuff tendonitis
• Knee arthritis
• Tennis elbow
• Trigger finger

Cortisone injections are also often used in lumbar and cervical spine problems. In these situations, patients may receive an epidural cortisone injection.

Pros

Cortisone injections can be an excellent treatment in many conditions that cause inflammation, but they aren't without potential problems. Sometimes even one small dose of cortisone can effectively eliminate the inflammation at the site of the problem and alleviate the pain.

Cortisone is easy to administer, and the side effects are minimal. Cortisone is a substance naturally produced by the body, and while the dose being administered is much more than your body would normally produce, the substance is well tolerated by most people.

The benefits of cortisone include:

• Cortisone is a naturally occurring substance
• Cortisone injections can be done with minimal discomfort
• Cortisone injections have few side effects

Cons

As mentioned, cortisone injections administer a high concentration of a substance that is normally only found in small concentrations in your body.

Laboratory studies have shown that high concentrations of cortisone or repetitive use of the medication can damage tissues in the body. This may lead to the softening of the cartilage in joints or weakening of the tendons.

In addition, various types of corticosteroid products can cause different problems. Some are safer on tendons or near skin, while others are safer near joints. Some are also longer-acting, while some are shorter-acting.

In older patients with worn-out joints or damaged tendons, the concern is less significant, because the damage is already done. The use of cortisone in young, healthy joints, however, should be done with caution. Therefore, high school or college-age athletes are often advised to exhaust all treatment options before considering a cortisone injection, and then to limit the number of injections given.

Certain tendons are also especially prone to rupture when treated with a cortisone injection. The most frequently encountered example is the use of cortisone around the Achilles tendon. Even when performed carefully, injections of cortisone around the Achilles can lead to traumatic rupture of the tendon.

Where It Stands

Cortisone injections are an excellent treatment for many conditions. In many patients with already damaged joints, such as patients with severe knee arthritis, it is unlikely the cortisone will contribute significantly to further joint damage. In these patients, an occasional cortisone injection may delay the need for joint replacement surgery.

Caution should be used whenever considering a cortisone injection for individuals with healthy joints, such as young athletes. In these patients, other treatments should be attempted first, such as oral anti-inflammatory medications, ice and heat applications, and physical therapy. If these treatments fail to provide relief, the cortisone should be used sparingly and in limited doses.