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, bursitis, among other conditions.

Some patients are concerned about the use of cortisone in their body. The common concerns that I often hear include:

• Cortisone is unnatural.
• Cortisone can cause joint and cartilage damage.
• Cortisone can lead to tendon rupture.
• Cortisone shots are painful.

Cortisone can be used for a variety of orthopedic problems. The medication works by decreasing inflammation. Anti-inflammatory medications can be taken orally, but this 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 a cortisone injection, 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.

Cortisone injections can be an excellent treatment in many conditions that cause inflammation. Sometimes even one small dose of cortisone can effectively eliminate the inflammation at the site of the problem, solving the problem.

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.

Among the benefits of cortisone are:

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

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 lead to damage of the tissues in the body. This may lead to softening of the cartilage in joints or weakening of the tendons.

The primary concern that patients should be wary of is the use of cortisone in young healthy joints and tendons. In older patients with worn out joints or damaged tendons, the concern is less significant, because the damage is already done. 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 limit the number of injections given.

There are also certain tendons that are 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.

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.

I think caution should be used whenever considering a cortisone injection into an individual 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.

Extra caution needs to be used in particular scenarios where cortisone injections have been associated with significant problems. These include cortisone injections for Achilles tendonitis, injections for plantar fasciitis, and several other specific scenarios.

Sources:

Cole BJ and Schumacher HR "Injectable Corticosteroids in Modern Practice" J. Am. Acad. Ortho. Surg., January/February 2005; 13: 37 - 46.

Fadale PD and Wiggins ME "Corticosteroid Injections: Their Use and Abuse" J. Am. Acad. Ortho. Surg., May 1994; 2: 133 - 140.