Although cortisone injections provide short-term pain relief from tendon injuries such as tennis elbow, their use produces worse long-term results than other treatments — or no treatment at all.
So concludes a new study that analyzed 41 previously published reports over the past three decades on the use of various treatments on nearly 2,700 patients with tendon injuries — such as tennis elbow, rotator cuff injuries and aching Achilles — where tendons become painful or torn, often from overuse.
The study's take-home message on the use of popular corticosteroid injections: Expect "short-term gain but long-term pain," lead author Bill Vicenzino of the University of Queensland, Australia, tells the Bulletin. "These injections have a high chance of success within three to six weeks." But six to 12 months after injection, patients in those studies had a 62 percent higher risk of relapse than those who initially did nothing, adopting a "wait-and-see" approach. And cortisone proved no better for tendon injuries than non-steroid-based treatments such as Botox, platelet-rich plasma and sodium hyaluronate.
The review study, published in the Lancet, did not analyze how age impacts injury relapse in those getting cortisone shots, a powerful anti-inflammatory. But tendinopathy "is generally a condition of middle age," notes Vicenzino, a professor of sports physiotherapy. "For example, tennis elbow occurs on average at age 45" and can last well into the 50s and 60s.
Sports medicine specialist Frederick Azar, M.D., says even though this review of studies suggests cortisone shots might do more harm than good, he finds they are an effective therapy when used prudently. "When used properly, in combination with physical therapy, bracing and activity modification, cortisone is very good — and in allowing time for proper healing, helps keep some people out of the operating room," says Azar, chief of staff at the Campbell Clinic in Memphis and a spokesman for the American Academy of Orthopaedic Surgeons.
"But no doubt, some people get a shot and use it as a license to get right back into what they were doing [that triggered the injury]. There is certainly room for abuse."
He acknowledges that cortisone shots — especially in weekend warrior boomers — can produce a false sense of security that could lead to later relapse.
His advice: "I like to see patients be pain-free for at least a week or two before they resume their activity, but it usually takes eight to 12 weeks to fully recover." After about two weeks of no pain, it's best to "modify activity," such as playing doubles rather than singles tennis.
Cortisone also causes an immediate spike in blood sugar levels — important for obese and diabetic boomers. And, notes Azar, team physician for the Memphis Grizzlies professional basketball team, no more than four injections should be administered within six months because multiple injections can weaken cartilage or tendons.
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Sid Kirchheimer writes about health and consumer issues.