Q&A: Why Cortisone Injections Can Be Controversial

Cortisone injections, also known as steroid shots, are a treatment option that brings out strong feelings in those who have tried them, either with or without success.

Cortisone injections can be very helpful in relieving joint pain, but the procedure carries some risks.
Read more: Cortisone Injection Risks and Side Effects

We spoke with Dr. Emmanuel Konstantakos, an orthopedic surgeon who specializes in treating joint pain and trauma, about cortisone injections and their role in treating arthritis.

    Q. Why do you think cortisone shots have such a mixed reputation? Can they be detrimental?

    Cortisone is a powerful steroid that reduces inflammation, and it can be a lifesaver for some people experiencing inflammatory joint pain. It has a mixed reputation, I think, for a couple of reasons.

    First, some people experience a “cortisone flare” after getting an injection, and this flare can be more painful than the condition being treated. The flare is temporary—it may last anywhere from a few hours to a couple days. The injection may still be effective over time, but that initial pain can be surprising and stressful.

    Second, cortisone has the power to weaken tendons and other soft tissue. This means that injections should never be made directly into a tendon, even if the tendon is what’s being treated. It also means people who get repeated cortisone injections risk tendon degeneration, called tendinosis or tendinopathy. That’s why we space out injections at least 4 to 6 weeks apart, and why we limit the number of injections a patient can get per year.

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    It’s also important to point out that people can incur tendon problems even if they’ve only had one accurately placed cortisone injection. For example, a person may get a cortisone shot and feel great, but the affected tendon is weakened, so when the person works out, he or she may unwittingly injure the tendon and make things worse. We sometimes prescribe physical therapy after a cortisone shot because a physical therapist can make sure you’re strengthening the joint without risking injury to it.

    Essentially, cortisone is a valuable tool for physicians, but it must be used judiciously and patients must be informed about caveats and potential risks.

    Q. Who is a good candidate for cortisone injections? Can you give examples of patients who typically benefit from these injections?

    The people who benefit from cortisone shots usually have one joint that is painful and inflamed and making life miserable. This type of isolated joint pain can be caused by bursitis, osteoarthritis, gout,pseudogout, and other conditions.

    For these patients, the cortisone injection gets the inflammation under control, allowing us to work together to treat the underlying problem.

    Q. If someone is not a good candidate for a cortisone shot, or has had one in the past without good results, what other treatments might be good options?

    It all depends on the underlying condition:

Every patient is unique and the choices we make regarding treatments must be tailored to his or her circumstances.

Ultimately, it’s important to remember that cortisone shots are not a long-term solution for treating pain. They are a way to temporarily relieve inflammatory pain and potentially buy time while the joint heals.

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