Hazards of cortizone?

[TennsDog]

I am currently in physical therapy for my stubborn tennis elbow. I have been in it for 4 weeks now with no results, whatsoever. I am thinking cortizone injection may be my best bet at this point, as I would like to be healed by the time the college tennis season starts. However, my therapist says that some doctors now are refusing to inject cortizone into the elbow. I know that it is not permission to go out and start all up again right after the injection, and it will still take time and some rehabilitation back into the game. I also know that it is best to have as few injections as possible, as multiple injections can prove hazardous. I am only thinking about getting the one injection, and I would like to know what some other people think and what some of the health risks are as to why some doctors won't inject cortizone into the elbow.

[Waimea_Boy]

It's spelled cortisone and it's not to be taken lightly. It's highly dependent on the skill of the doctor and their being able to pinpoint the EXACT location inside your elbow to inject. Cortisone does a great job of eating up inflammation, but it also eats up cartilage.

I'm assuming that your tennis elbow is on the medial side of your elbow, yes?

[bcaz]

Corticosteroids are miracle drugs but they are not panaceas. Surgeons will use them in some areas of the body but not in others. For example, as far as I know, it is too great of a risk to give an injection to the achilles tendon. Alternatively, they can be effective in the hip, back, hamstring and shoulder, even the scalp, if properly administered. Most any doctor will avoid the needle until less invasive therapies have been tested -- rest, physical therapy, NSAIDs, etc. Be patient and listen to your doctor. It may well be that the elbow is a risky place to inject corticosteroids.

[MCN]

Cortisone has to be administered exactly in the right location - so make sure you get someone who can hit the spot. You'll know when it does cause it hurts like hell (only for about 10-15 seconds though). General guides from the surgeons / specialists I've seen is that you can have up to 3 or 4 in one year (in a joint that is NOT weight bearing). I've had 4 injections over 15 months or so in my elbow. The first two worked really well - completely shut out all of the pain for around 2 months BUT pain came back once the effects wore off (my TE is quite bad and is still persisting). The next two I had missed the point of damage and as a result did nothing for me. In any case, if a couple of injections don't help get rid of the problem over (say) 6 months, it's unlikely that it's worth pursuing that course of treatment. I've had more since my TE is really painful - especially at night as it keeps me awake. The only reason I may have another is to get rid of the pain for a couple of months to allow me to pursue more physio. I have heard from some other people that cortisone worked first time for them - reduced the swelling, allowed them to do physio and that cured everything. In my case, unfortunately, it's still persisting. So general adice is, speak to good doctor/physio and if you do get an injection, ensure you follow advice after - that may be complete rest or lots of exercises. If symptoms return after a couple of months its unlikely that further injections will help (apart from short-term relief).

[whodat]

Cortisone shots do alleviate the tendonitis (technical term for tennis elbow) of the brachioradialis muscle (there are three tendon attachments of this muscle to the humerus (funny bone/upper arm bone). Having said that, the injections weaken the tendon and cause a false sense of healing that translate into overconfidence when hitting one's strokes. Under the decreased pain sensation the tendon can weaken further, develop chronic tendonitis, or rupture (worse case scenario). The best therapy for TE is rest, followed by strenghtening exercises, change of stroke, and change of strings (something softer like a multi or gut). If you must play--and we are all addicts here--use a small wrap around the belly of the muscle (about 2/3 of the way from the wrist to the elbow to decrease the tension to the tendon.

[Dimethyl Sulfoxide]

Lots of misinformation here! There has never been any proof that cortisone damages or weakends tendons. There are risks with Cortisone just as any other drug but those named in this thread are simply unproven. Most people just do not know what Cortisone does to the body. Please speak to your doctor or orthopedic surgeon.

[North]

There is controversy surrounding the extent to which intra-articular (into the joint) steroid injections may damage tissue. Taking oral steroids for prolonged periods is known to cause damage to joints. Accordingly, most doctors try to avoid steroids, by any route, or use as little as possible for as short a time as possible. If you want to go the steroid injection route, like the other posters have said - make sure you find someone who is top-notch at injecting the right place. There are a number of documented studies and reports of tendon rupture due to direct injection into the tendons and many physicians will not do a direct tendon injection because of this.

Good luck with whatever you decide. Have you tried more arm-friendly racquet/string setups?

[TennsDog]

I have not even played tennis (with my right hand) for two months now. That is why I am looking into Corisone. The pain isn't glaring, just bothersome and I notice it at times for no reason. I am taking physical therapy, but it isn't doing anything. I have tried arm bands, nothing. Naproxin isn't doing a whole lot eiither. I have gone to Iso-Speed Control at a low tension, but I have not played with it for a while because of my elbow. I know all the ways to heal TE, and I know that rest is required for all methods. I will not take Cortisone and be back on the courts the next day...I'm not stupid, I would like to be able to continue playing for more than a year following. I am just interested as to any reason why I should NOT get it done, keeping in mind that I will not play again for a month after the injection, and I do exercises. Also, isn't the biggest point of Cortisone to help with the pain so that one can get back to helping it heal? I don't have any real "pain" as much as continued annoyance that I know is from TE, which will flare up dangerously as soon as I try a serve. Is Cortisone still worth a try? I know, and yes, I am contacting my doctor.

[whodat]

Lots of misinformation here! There has never been any proof that cortisone damages or weakends tendons. There are risks with Cortisone just as any other drug but those named in this thread are simply unproven. Most people just do not know what Cortisone does to the body. Please speak to your doctor or orthopedic surgeon.
The person that I talked to concerning cortisone shots is a board certified pain specialist who does multiple steroid shots. In his opinion repeated use of steroids to decrease the pain from inflammation can (not will) weaken the tendon. I asked specifically about TE.

[GOOOOOGA]

first of all, the original reason why cortisone shots are taken is for patients suffering from Addison's Disease. cortisone is a hormone frome the adrenals, and its absence can cause major problems in your body's ability to do everyday tasks. my dad, who is a doctor, told me that his collegues told him that they're reluctant to give a cortisone shot to a person without AD. it decreases inflammation and removes scar tissue. HOWEVER, it DOES have a debilitating effect on cartilage and tendon if it is injected DIRECTLY into tendons/cartilage or into a joint.

even when people DO decide to get a cortisone shot in a joint, the main places one is done are knees, shoulders, and ankles. not elbows. the joints are the most "high risk" spots to get a shot taken. normally, its patients who have shots taken in joints that end up having the most severe and serious side effects. these can include heart and liver problems.

an alternative to cortisone shots is Prolotherapy. this is "nonsurgical ligament reconstruction", treatment for chronic pains. this is completely different from cortisone shots because prolotherapy lets the body cure itself. a sugary solution is injected into the area, causing local inflammation, which means more blood in that area (meaning more nutrients and such), stimulating the body to repair itself. visitwww.prolotherapy.com for more info

cortisone shots can be risky, there's always the chance of complications

[Yours!05]

an alternative to cortisone shots is Prolotherapy. this is "nonsurgical ligament reconstruction", treatment for chronic pains. this is completely different from cortisone shots because prolotherapy lets the body cure itself. a sugary solution is injected into the area, causing local inflammation, which means more blood in that area (meaning more nutrients and such), stimulating the body to repair itself. visitwww.prolotherapy.com (http://www.prolotherapy.com/) for more infoGetting some good results from Prolo here in Oz. http://www.prolotherapy.com.au/

[stalliondan]

take it from me man, I took two cortisone shots in between the joint of my big toe on my left foot during my second year of college tennis in order to play nationals and the only thing it did was mask the pain. Yes I was able to play but what happened was that I was not feeling what I was doing to my foot and now it hurts every single day and to correct the problem it will involve non guaranteed surgery. Do what you want broski but I thought you should hear my story.

[TennsDog]

That was because you played right away and kept doing what hurt it. The idea for cortisone is to help it heal while you are not abusing it. That is what I said, I would not be playing right away after the injection because that is what happens when you do.

[mhldex]

The first injection I took lasted for about 4 months and then my TE recurred. It was much worse than the first time I had it; doctor told me I did not allow enough time for healing before hitting the courts.

So my doctor gave me another shot and this time, I was told to lay off for a longer time to allow better healing. It is now almost 8 months since my second shot; I no longer feel pain but I do notice that my elbow looked somewhat discoloured and apparently there's some loss of muscle tissue/fat surrounding the area of the injection.

All I am saying is that cortisone does have its side effects and I am now not taking any risks by going back to the courts too soon. I try to do the prescribed exercises regularly; but am still keeping my fingers crossed that my recovery will be complete one day........

[TennsDog]

Rather all of the sudden, my pain went away. I just finished therapy, and the pain is virtually gone (not sure how much the therapy actually helped, though). I have been on the courts twice with very little pain after. I am now taking about another 2 week break to help myself get back in, but the cortisone idea is now out the window.