Caution When Considering Cortisone Injections
Give Careful Consideration to Both Side Effects and Appropriate Use
The purpose of a corticosteroid (cortisone) injection is to place anti-inflammatory medication directly into the area of the body that is inflamed. According to the American Orthopedic Society for Sports Medicine, cortisone injections have been used by physicians since the 1950s to treat inflammatory conditions including tendinitis, bursitis, and carpal tunnel syndrome.
Cortisone injections are a controversial topic with advocates on both sides of the fence. Anyone considering a cortisone injection should carefully research the purpose, procedure, appropriate use, side-effects, outcome of treatment, and length of relief prior to making a decision.
What is Cortisone?
Although naturally produced by the body, the cortisone used for injections is a synthetic compound similar to what the body naturally produces. Cortisone is an anti-inflammatory medication. It is designed to reduce inflammation in and around a painful area. Pain is reduced because the inflammation is reduced.
Because this medication is an anti-inflammatory, it is designed to work in conditions for which pain is primarily caused by inflammation. Tendinitis is an inflammation of a tendon. Bursitis is an inflammation of a bursa. Injecting cortisone directly into the inflamed area of these tissues may quiet the inflammation around the tendon or bursa thereby reducing the pain.
Cortisone Contra-Indicated for Acute Injuries
Cortisone injections are not to be used for acute injuries. An acute injury is an injury that has a specific mechanism of injury (sprain, strain, fracture, subluxation). According to Dr. Brian Bowyer, MD, Ohio State University Sports Medicine and Family Center, “A steroid injection can actually interfere with healing following an acute injury.”
For example, injecting cortisone into a knee with a new ACL tear is not going to relieve the pain of the injured ligament or make the knee stable again. The anesthetic initially given prior to the injection may relieve the symptoms for a few hours, but the pain caused by the injured tissues will return.
Inflammatory Process
In an acute injury, it is important to allow the inflammatory process to run its course. It is this process that is responsible for the physiological healing of tissues within the body. The three phases of the inflammatory process allow the body to control and contain the injured area, remove injured/dead cells from the area, and lay down new collagen tissue to heal the area.
With proper rehabilitation, the last phase of the inflammatory process allows the new collagen tissue to realign and strengthen. When this has occurred, the injury is considered to be healed and fully recovered. Depending on the type and severity of the injury, this process can take a few days up to one year.
Because the body’s tissues need the inflammatory process to heal, an “anti” inflammatory medication inhibiting this process would be contraindicated.
There are some who believe that corticosteroid injections should not be used in athletes. The claim is that cortisone injections inhibit the healing process and actually damage and weaken the connective tissue to which it is injected. Athletes may mask their pain with a cortisone injection then cause additional damage to the injured tissue while competing making the original injury worse.
Side Effects of Cortisone Injections
Documented side effects of a cortisone injection listed by the American Orthopedic Society for Sports Medicine include:
- Cortisone “flare” (condition in which the pain increases in the area following the injection, but subsides with ice)
- Whitening of the skin around the injection site
- Infection at the injection site
- Drop in blood sugar level in a diabetic
- Softening of cartilage (with repeated injections)
- Weakening of tendons (with repeated injections).
Because of possible damage to connective tissue, for those who choose to receive a cortisone injection, physicians usually recommend no more than three injections during any given year with injections given no closer than three months apart.
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