Cortisone Shot: Is this Magical Pill Worth It?

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What is the magic pill?

The magic pill I am referring to is a corticosteriod injection, also known as a cortisone shot. Chances are many of you know someone or even you yourself have experienced going under the needle because of shoulder, elbow, Achilles, or maybe knee pain. But did you know why?  Were you educated on the benefits/risks? Was the actual cause of the pain ever addressed?

What the research has to say

The cortisone injection is an anti-inflammatory drug administered by a medical doctor and has become the preferred treatment for many overuse injuries such as tennis/golfer’s elbow, Achilles tendon pain, and shoulder bursitis and/or impingement. In 1954, the first clinical trial for corticosteriod injections revealed immediate short term relief, a finding also established in many recent studies. However, the same clinical trial discovered relapse of the injury within six months.

However, the same clinical trial discovered relapse of the injury within six months.

In 2010, an article published in the British Medical Journal examined patients with shoulder impingement who either underwent both a cortisone injection and physical therapy or only physical therapy. At week one and six, those who had the injection demonstrated less pain and improved function, but at week 24, there was no difference among the two groups.

Is the quick fix worth it?

So are the risks of cortisone shots worth the short term relief? Other studies have shown a much lower rate of full recovery for patients who received cortisone shots compared to those who only received physical therapy or simply did nothing. One study found there was a 63% higher risk for a relapse of the initial injury in those who received only a cortisone injection. Another study revealed persons who had received an average of four injections had a 57% worse outcome of full recovery than those who received one injection. Because the cortisone shots seem to affect the neural receptors which may mask the pain, people might risk further damage by returning to certain activities when the tissues are still fragile.

Because ortisone shots seem to…mask the pain, people might risk further damage by returning to certain activities when the tissues are still fragile.

But is it really inflammation?

One reason cortisone injections may not be beneficial for someone experiencing joint pain could be that the overuse injury is degenerative, and not due to inflammation. Many people have been diagnosed with an inflamed tendon (i.e. tendonitis) and therefore get treated with this anti-inflammatory drug. The problem is many studies have shown that these overuse injuries do not involve inflammation but instead have degeneration or “fraying” of the connective tissue (tendon). This type of condition is commonly termed as tendinopathy. When these conditions are treated with corticosteriods, the structural damage is not healed and some research supports that it could actually impede on the healing process weakening the connective tissue further.

Find the cause, don’t just treat the symptoms

It is crucial to understand that the magic pill does not address the underlying cause of an injury.  It only treats the symptoms. Remember, the quick fix may be damaging in the long run. In conclusion, do your research, talk with your doctor, meet with a physical therapist, and understand your condition before jumping under the needle.

Don’t put a Band-Aid on a wound that needs staples.

-Dr C

 

References

Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ. 2006; 333:939.

Buchbinder R, Green S, Youd JM. Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev. 2009.

Coombes B, Bisset L, Vicenzino B. Efficacy and Safety of Corticosteriod Injections and Other Injections for Management of Tendinopathy: a Systematic Review of Randomised Controlled Trials. Lancet. 2010;376(9754):1751-67.

Crawshaw D, Helliwell P, Hensor E, Hay E, Aldous S, Conaghan P. Exercise Therapy After Corticosteriod Injection for Moderate to Severe Shoulder Pain: Large Pragmatic Randomised Trial. BMJ. 2010;340.

Johansson, Kajsa; Bergstromb, Anna;  Schroderb, Karin and Foldevi, Mats. Subacromial corticosteroid injection or acupuncture with home exercises when treating patients with subacromial impingement in primary care–a randomized clinical trial. Fam Pract. 2011; 28:355-365.

Rhon D,, Boyles R, Cleland J. One-Year Outcome of Subacromial Corticosteriod Injection Compared With Manual Physical Therapy for the Management of the Unilateral Shoulder Impingement Syndrome: A Pragmatic Randomized Trial. Ann Intern Med. 2014; 161(3):161-169.