Since the 1950s when it was invented, a cortisone shot has been used to treat many painful joint and tendon overuse injuries. Cortisone is a potent anti-inflammatory. People now receive a cortisone shot for tendon pain such as tennis elbow, and in the knee for conditions such as osteoarthritis. Over the last decade a significant body of research has shown that these shots may not be as effective as we thought… and in some cases they may delay healing.
A cortisone shot is often recommended as the treatment for severe pain due to tennis elbow, rotator cuff related pain and arthritic joints. There’s little doubt that many will notice a dramatic improvement in pain within a short period of time after a shot. Patients who receive a cortisone injection for a painful tendon usually notice the pain is worse for a day or so and then the pain will subside. Unfortunately, their tendon pain will usually return within a few months after the cortisone shot.
Cortisone Shot Uses
Back in the 1950s Orthopedic Surgeons felt that tendon pain was due to inflammation.. or tendonitis. Many years ago we were proven wrong. Most tendon related pain is due to degeneration or wearing out of the tendon. Think of your favorite pair of blue jeans. The knee fades, then frays, then you have a hole — it wore out. This process is known as tendinosis. It is not an inflammatory condition. Researchers now believe that the cortisone shot helps alleviate pain due to an effect on the nerves in the region that was injected. The cortisone does not cure the tendinosis. As a matter of fact, it can delay the healing or cause worsening of the tendinosis.
We know that conditions such as tennis elbow and rotator cuff tendinosis are often self limited entities. That means that the pain will often subside over time, usually with a physical therapy program. Researchers have found that in patients with tennis elbow, if they received a cortisone shot, they had relief of pain, but after the pain returned, it took them longer to fully recover when compared to patients who did not receive injections.
A cortisone shot is debatably useful in patients with very severe pain… which is significantly interfering with their quality of life. But in those cases, you should understand that you are trading off a brief period of pain relief for a more protracted recovery time.
For osteoarthritis of the knee, or in cases of joint pain due to gout or other similar causes of pain a cortisone shot may be beneficial in the short term as well. Many patients with arthritis have mild or moderate pain that is managed with compression sleeves, physical therapy and perhaps with over the counter medications. Occasionally we see patients with very severe pain which developed overnight … perhaps due to overuse. In cases of pain due to gout or arthritic inflammation and swelling a cortisone shot may be very useful. A cortisone shot will not treat the arthritis, it will not reverse the arthritic changes and it will not delay the inevitable knee replacement surgery. But it may give you significant short term relief. In those of you with chronic long term pain and swelling, cortisone shots offer only a limited, transient benefit.
Cortisone Shot Risks
Cortisone shots are not without risk. Injections into certain tendons can lead to a tendon rupture or tear. Frequent injections will cause signifiant issues with your bodies own cortisol production. Cortisone shots in diabetics will elevate your blood sugar, sometimes to very high levels. Anytime a needle is injected into a joint or tendon there is also the risk of infection. Cortisone shots within 2-3 months of a knee or hip surgery increases the risk of infection
The cortisone shot continues to have a role in the management of painful tendons and joints. But that role is becoming more limited as we learn more about why our tendons degenerate and how cortisone might impact healing. You will need to ask yourself… is an injection (quick fix) now worth the potentially negative effects on long term healing?