Cortisone Shots - Good or Bad?

[slewisoh]

I have personally never had a cortisone shot, although several doctors have recommended them to me. I've read they can make tendons very brittle. And then there is the matter of that big needle...:eek:

Just wondering what others have experienced.

[North]

What would you be getting the cortisone shot for?

[El Diablo]

For shoulder or elbow, for example, orthopedists I know say one shouldn't have more than two or three shots total in any one area.

[Marius_Hancu]

FWIW
http://tt.tennis-warehouse.com/showthread.php?t=90800

[slewisoh]

What would you be getting the cortisone shot for?

I've had them recommended for all sorts of ailments. In my early twenties I had spontaneous swelling and stiffness in both ankles and a doc suggested cortisone shots as a way to "calm things down." As it turned out, I have rheumatoid arthritis - don't think cortisone shots would have been a good idea to treat that condition.

More recently I've had some relatively mild shoulder impingement. Even though the pain level was only moderate, the orthopod suggested a cortisone shot again "to calm things down."

There have been other situations that were similar, but in each case it just didn't seem like an appropriate treatment.

[North]

You would most likely get at least some, maybe a lot of, relief from the cortisone. If you ask around, you can find people who will sing the praises of steroid injections into joints. The pain relief could last a few weeks to couple of months.

Most of what you will find if you do a Google (or any search engine) search on the subject will be tons of stuff on the safety of the procedure and the promise of quick pain relief. Even on the medical sites presenting information to doctors, the dangers of joint injection are not always stressed. (I guess if you are writing an article about a procedure you do as part of your job, you might not want to dwell on the negative aspects of it.) But even there the very real ability of steroids to damage joints is clearly stated (look up the phrase "aseptic necrosis"). And definitely check out the link Marius provided.

If you are having unbearable or intractable pain refractory to all other measures you have tried, it might be worth it, especially since the risks don't really start to mount until after 2-3 injections into a given joint. The temporary relief might allow you to start all the other measures for long-term relief. BUT... The operative phrase there is "all other measures". Probably (just my obsevation) many people are unwilling to put in the time and committment to do the rehab, daily exercises, possible equipment changes (though I recall you recently got a new racquet, right?), and lasting lifestyle changes that are included in "all other measures". Small wonder doctors simply push the quick fix.

Only you can decide. If you are having misgivings about the cortisone shot (which is a wise misgiving) talk to your orthopod and see if he/she will work with you long-term to keep your shoulder away from anything sharp (needles, scalpels, etc).

Incidentally, steroids are sometimes used to treat rheumatoid arthritis. A review article on this: www.postgradmed/issues/1998/02_98/genovese.htm

[vinky]

There are sacs of liquids called bursas, i think.. if that's the wrong name, oh well. But they are found between tendons and muscles which prevents them from rubbing against each other and causing pain. When these sacs swell up for some reason, they can cause a lot of discomfort, and i think that's where cortisone shots come in. I think if you need them, it's better to take them than to not take them.

[travlerajm]

Cortisone shots are notorious for causing further injuries. The problem is that you feel great after the shot. So then you go play tennis as if you're healthy, and then - SNAP - you're out for good.

[heycal]

Here's my experiences with cortisone shots:

Seven years ago, I had a chronic tendinitis type injury in my shoulder that developed from lifting weights. I visited a few doctors. Finally one of them talked me into getting a cortisone shot despite my skepticism about quick fixes and my fear of all the evils I'd heard about coritisone. And to my utter amazement, it worked like a charm. Shoulder was more sore than usual for a week or two, but then the pain went away. Forever. Never came back.

Cut to this January: Suffering from TE, I eagerly get a cortisone shot so I can get back to tennis quickly. But this time it does absolutely nothing.... No apparent benefit. (Or harm.)

The moral of the story? It might work well, or it might not work at all. Different people, and probably different injuries, react differently. But scary stories aside, virtually everyone with a medical degree believes a limited number cortisone shots aren't going to kill ya.

[jaykay]

I have had a cortizone shot only once in my left knee. The injury sustained was diagnosed to be 'bursitis' on the inside of my left knee, caused due to 'over-use syndrome'.

The needle is pretty big and that area hurt for a couple of days (not because of bursitis, but because of the shot).

The pain caused by the shot went away after a few days and the pain due to bursitis also went away after a while. Pain relief was NOT instantaneous.

So, all in all, I'm not sure whether the cortizone shot helped me at all both from the perspective of pain management or from the perspective of expediting healing of the bursitis injury.

[heycal]

I don't know who's claiming "instantaneous" pain relief from a cortisone shot. And in your case, if your ailment improved in the wake of a cortisone shot, regardless of whether it took a few days or a few weeks to work, cortisone might deserve the credit for speeding your recovery.

As for the pain of the shot itself? I didn't love getting stuck either time I've had the shot, but 10 seconds of pain from an injection beats months of pain from whatever injury you may be suffering from -- hitting backhands with a bad case of TE hurts way more than a cortisone shot in my opinion. (Though again, in my case cortisone did nothing for my TE but did help with a shoulder injury years earlier.)

[slewisoh]

Years ago my retired father in law took up swimming with the intent being to save on the wear and tear of his body. He promptly injured his back and was in terrible pain for months on end. This is the most stoic sensible man I know yet he reached the point where he was trying hypnosis and mail order "miracle" creams to reduce his pain. It finally went away after about six months.

He went back to running of all things, and competed in the Senior Olympics for the state of Tennessee. Actually, my MIL also competed - threw the javelin. She could also clean up in ping pong, back in the day...

I digress - the point was supposed to be about the effect that constant pain has on people. The sane go insane, the mild mannered turn into beasts...

[jaykay]

I digress - the point was supposed to be about the effect that constant pain has on people. The sane go insane, the mild mannered turn into beasts...

... Very true... Couldn't have said it any better! :)

[sotua]

As for the pain of the shot itself? I didn't love getting stuck either time I've had the shot, but 10 seconds of pain from an injection beats months of pain from whatever injury you may be suffering

Well, if you have (un)reasonable loathing of needles...

I tore an ACL in my right knee (had so much torsion that my rotula pointed to 12 o'clock and my foot pointed to 4/5 o'clock). I had the reconstructive surgery, went home, a week later I had a fever and had to go back to the hospital. The doctor took a big hypo and took fluid out of my knee (both for culturing to see if I had an infection and to relieve some pressure in the just-operated knee).

I can't decide what is the most physical pain I've felt in my life, if the actual tearing of the ligament or the draining hypo!!! ;)

hitting backhands with a bad case of TE hurts way more than a cortisone shot in my opinion. (Though again, in my case cortisone did nothing for my TE but did help with a shoulder injury years earlier.)

You shouldn't be hitting BHs with a bad case of TE!

[Hokiez]

Well to revive an old thread, I have to sing the praises of cortisone. I've had a rotator cuff problem for the last 7 months and have played through it, took breaks, went to PT and even switched racquets and strings with small gains, but usually only after a full month of not playing and the pain was still there, just less pronounced. I went in Tuesday, had the injection. Tuesday evening = no pain. Wednesday = some pain (from the injection), Thursday = less pain, Friday = no pain at all. I played Saturday and have absolutely 0 pain.

I can't say enough good things about the cortisone injection. I think the last 5 weeks of PT to build strength and then the injection to overcome the last hump was really key. The injection probably got rid of the last bit of inflammation/irritation/injury and the strength and conditioning from the PT likely prevented me from re-injuring it.

[theace21]

I had micro fracture surgery on my right knee 2 years ago...I was in such pain, I couldn't get my leg into the car, couldn't get off the toilet - My doctor said I could get a cortisone shot and it would help...He was a tennis player and I asked him what he would do - he said get the shot.

I did and within a couple of days, I felt 100% better - Find a doctor you trust and ask them what they would do if it was them or their son/daughter...

[LuckyR]

Steroid injections are a great idea to speed healing of something that is going to heal on it's own but is taking too darn long. Naturally when used this way it is a one time injection.

However, there are well known risks to long term steroid exposure. But to say those effects are likely with a single injection is using baseless scare tactics.

[Serve em Up]

I can't say they are good or bad. I tore a ligament in my ankle when I was 25.After weeks of pain with little improvement my doctor tried Cortisone. It made it worse immediately. The doctor siad it was the needle and temporary. It ended up being worse for weeks.

Not a definitive answer just my personal experience.

I have seen ortho anti-inflammatories work wonders. Prednisone for instance. It cleared up my fathers sciatica within 12 hours of treatment when he had inflamed cartilage pinching a nerve.

[NLBwell]

Cortisone will make the swelling go away. In a lot of injuries, the swelling becomes the major cause of the problem, as the swelling causes rubbing (against bones, other tendons, etc.), pniching, and irritation, which causes more swelling, which, of course causes more irritation, and so on. The cortisone can often break this cycle. If there is something structurally wrong (or if your strokes caused it in the first place), the problem likely will come back or even not go away.

[Hokiez]

Cortisone will make the swelling go away. In a lot of injuries, the swelling becomes the major cause of the problem, as the swelling causes rubbing (against bones, other tendons, etc.), pniching, and irritation, which causes more swelling, which, of course causes more irritation, and so on. The cortisone can often break this cycle. If there is something structurally wrong (or if your strokes caused it in the first place), the problem likely will come back or even not go away.

100% agree and was the situation for me. I had swelling in the rotator cuff that would not go away since daily activities would continually, though only slightly, irritate it to the point it wouldn't get any better. 1 shot = complete cure. I've played 4 times in the last 7 days and have zero pain (other than some strain in some muscles from not using them but no shoulder pain). Long term they can deteriorate the tendons and even the bone and connective tissuess, but as a single shot to repair damage from a unique event, I can't recommend it enough.

[knasty131]

100% agree and was the situation for me. I had swelling in the rotator cuff that would not go away since daily activities would continually, though only slightly, irritate it to the point it wouldn't get any better. 1 shot = complete cure. I've played 4 times in the last 7 days and have zero pain (other than some strain in some muscles from not using them but no shoulder pain). Long term they can deteriorate the tendons and even the bone and connective tissuess, but as a single shot to repair damage from a unique event, I can't recommend it enough.

Hokiez, how old are you??? I have had these shots and yes they do take the pain away...but it is my understanding that they should not be taken extensively. Be careful and definitely get second opinions when dealing with health issues that can cause long term damage if not taken care of properly.

[Hokiez]

I'm the ripe old age of 32. I really did it to myself. I did heavy weight training all winter and got physically strong in my chest and arms, but didn't do any substantial back and shoulder work and after playing tennis for the third time in the spring/early winter, it began to hurt one evening after playing and hurt consistently for the next 6 months. I did 4 weeks of PT to strengthen the shoulder, and another 4-6 may have fixed it but when given the option of 4-6 weeks of PT (really just rest and conditioning) or an instant fix, I took the instant and have kept up with the PT.

I highly recommend PT first to get the affected area in shape and strong enough to handle the activity in question. If you don't do this first, you'll end up re-injuring the area and completely negating the good that was done.