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Thursday, January 17

Are Cortisone Injections Bad for You?

I give many cortisone injections in my practice because cortisone is a powerful, effective anti-inflammatory.  Most shoulder problems are the result of inflammation, and cortisone is the most effective medication to treat inflammation.  Period.  Why do I use cortisone injections?  Because they work really, really well.  Like any medication, though, cortisone has benefits and risks.  Here I will try to answer common questions about cortisone injections.

First, what is cortisone?  Actually, cortisone is just one of many medications in a group called corticosteroids.  Other corticosteroids include prednisone, prednisolone, methyprednisolone (medrol), and dexamethasone.  Most people just say cortisone to mean any of these medications.  Cortisone and the other corticosteroid medications work by decreasing the body's immune response--it is an anti-inflammatory. Inflammation is the immune system flaring out of control and causing pain.

Is cortisone just a "temporary fix"?  For many people, a single cortisone shot is an effective, permanent solution to an inflammation problem.  If inflammation is like a fire, then cortisone is the water to put the fire out.  Sometimes the fire, or inflammation, is completely eliminated by the cortisone.  Sometimes, though, inflammation remains, and can flare back up.  For some people, the cortisone shot doesn't put out the fire completely and they have pain and inflammation come back.  And for some people, the injection doesn't work at all.

Doesn't cortisone damage the tendons and ligaments in my shoulder?  There may be a very small effect on the tendons in the shoulder.  However, a single injection is absolutely safe and causes no weakening.  With multiple injections, however, there is a risk of weakening tendons in the joint.  If multiple injections might be necessary, then you should know about this small but real risk.

Are there any other side effects of cortisone?  In patients with diabetes, cortisone may cause a temporary increase in blood sugars.  This effect wears off after a week or so.  There is a small increased risk of infection after a cortisone shot, because the shot decreases the body's ability to fight infection. 

How is the injection given?  In my practice, I use a small ultrasound machine to guide the injection into the correct location.  Here is a video of a cortisone injection:

8 comments:

Anonymous said...

I have had three doses of steriod shots by Dr. Frisella over the last year and a half for a torn rotator cuff. Have had minimal pain over the last 6 months!

Huge song collection said...

Thanks for your information....I have been suffering for shoulder pain last 1 year. I hope, this will help me.Pharmacology

Valerie said...

I really appreciate your effort of sharing this information, it's really helpful. But I guess I'll just stick to taking joint support supplements since mine is not that severe.

Dean Aynechi said...

Thank you Doctor Frisella for this article:

I have had two cortisone shots in my knee. I was wondering if the threat of tendon weakening is correlated to the number of injections or to the duration? For instance, would it be riskier to have two injections within 3-months, or three injections within 3-years? Thank you.

Dr. Frisella said...

Dean, it's definitely better to have the injections spread out than close together. It depends on how old you are, but patients younger than 50 should really try to minimize injections to every 6 months or so at the most, and to minimize the total number of lifetime injections. For patients older than 60, every 3 months is probably reasonable, but again the focus should be on minimizing the number. If you're needing injections more often, it might be reasonable to consider surgery.

Stefanie A said...

What is the rationale for no more than 2 within 6 months? I'm 38, have had shoulder pain (bursitis and tendonitis) since September. Cortisone shot in Han seemed to be working and I was gradually returning to arm exercises (no over the shoulder, but light trx, light weights, planks/push-ups). Then it seemed that doing mountain climber as part of training circuit set it off and I've had intense pain shooting down my arm since last week. I've done no arms since last wed and no activity at all for 4 days and not improving. My doctor is hesitant to give another shot but pt did not work last time-

Anonymous said...

Hello, What is the next step for a shoulder in which a cortisone shot does not work? I have spent 3 months in PT with little relief for shoulder pain since this shot. Doc says its tendonitis but mri shows multiple small partial tears of rotator cuff, Doc said they were small so they don't count. I am so lost and confused. Living in agony. Any suggestions would be great. Thanks
Melissa

Dr. Frisella said...

For a patient who has had therapy and injection, it is appropriate to consider arthroscopy to debride (or clean up) small tears, look to see if the tears might be larger than they appear ont he MRI, and to remove bone spurs under the acromion that might be rubbing or causing impingement. Another cortisone shot might also be a good idea before proceeding to surgery; it's possible that a second shot would help when the first didn't. Good luck!

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