What is Cortisone and What Does a Cortisone Shot Do?
Cortisone or Steroid?
““The term cortisone has gotten to be so ubiquitous that we often use that term rather than the more accurate term “steroid”, and you may see that throughout this article. Think “xerox” when we really mean “copy”, or “Kleenex” when we really mean “tissue”, and you’ll get the idea.”
A Note About Cortisone
Cortisone is a 30 year old medication that we rarely use anymore. While it is a very strong anti-inflammatory medication, it also had some destructive properties to the joints and tendons.
The newer, more synthetic, steroid anti-inflammatory medications are in our system for a much shorter period of time.
Typically, there is no trace of them in our body after 7 days, yet their anti-inflammatory effect still lasts. Additionally, they don’t seem to have the same destructive effects to our joints.
“Dr. Steadman and I published on this 10 years ago showing these newer medications in a horse model did not damage the joint, whereas cortisone did. That’s why most of us wouldn’t do more than 3 injections in a year into a knee or shoulder.
”
So make sure you ask for any of the newer anti-inflammatory steroids. With modern medications, we often won’t do more than 3 or 4 in a year but for different reasons.
If the steroid isn’t creating a long-term benefit, its time to think about other forms of treatment.
What exactly is Cortisone?
What is Cortisone
Despite my previous recommendation, I'm going to drive on and quickly shed some light on what exactly cortisone is.
Cortisone is an injectable corticosteroid medication that is used to relieve the pain of inflammation. It's often prescribed to combat the following:
- Tennis elbow
- Carpal tunnel syndrome
- Tendonitis
- Arthritis
Cortisone is naturally produced in the body through the adrenal gland and released when the body is under stress. By minimizing inflammation, injectable cortisone can provide significant pain relief.
Cortisone shots - How do they work?
Cortisone in not actually considered a "pain-reliever." Although it does provide a pain-abating effect, its properties actually derive from its ability to minimize the reaction to inflammation.
A side result of this is less pain, hence the reputation as a "pain-reliever."
The primary factor that led to the popularity of cortisone is that it can be injected directly into the spot on the body which is having the inflammatory issue.
CORTISONE SHOTS - MOre potential issues
Issues
We want to have a level of caution when using cortisone to treat injury. Why? We don't want to create the appearance of a fully-healed joint before it is actually fully healed, risking further injury.
You may receive a cortisone shots to ease the pain and inflammation, but you still always want to show caution when it comes to the injury. A cortisone shot can certainly create the appearance of full healing, leading to a risk of re-injury if proper rest is not achieved.
Thinking of pain as the body's natural "alarm system" is a good way to look at it. With the alarms turned off, we need to be extra cautious.
CORTISONE INJECTIONS- Are They illegal steroids?
Nope. Cortisone shots are perfectly legal and are not to be grouped in the same category as the anabolic steroids that have dominated the professional sports headlines in the past.
Anabolic steroids help athletes gain an unfair advantage by allowing them to train and perform at higher rates of productivity. Cortisone is used to treat inflammation, putting it in an entirely different category.
CORTISONE INJECTIONS - Are they for everybody?
Like I said earlier, there are much better alternatives in our present day. But, as always, everyone's case is going to vary based on a number of factors, and my recommendation is and always will be to consult your doctor before undergoing any treatment.
In particular, you should be wary of the following conditions when it comes to cortisone shots:
- Joint infection
- Skin infection that may be an allergic reaction to a previous cortisone shot
- Acute injuries such as broken bones
- If you are currently using blood thinners
For athletes
Athletes
Also, if you are an athlete wanting to jump into the fray and looking to have a cortisone shot injection into an inflamed joint or bursa sac right before or during a game or competition, I would recommend otherwise. The injury may just become exacerbated and damaged further.
CORTISONE INJECTIONs - are there side effects?
Side Effects
Diabetics Take Caution
Diabetic patients may experience an increase in blood sugar levels for up to two days after receiving a cortisone injection.
If you are diabetic, please take extra care to consult your physician and take the proper steps to monitor your health after you receive the shot.
Cortisone Flare
You may have heard of the so-called “cortisone flare” reaction - which is reported to occur in approximately 2% of patients treated.
Cortisone flare occurs when the injected cortisone undergoes a crystallization process, creating more pain instead of eliminating it.
Luckily for those who deal with cortisone flare, the reaction is short-lived. when treated with ice, it can disappear within 24 to 48 hours.
whitening
Another side effect (which is more annoying than painful) is a "whitening" of the in the area of the injection (This side-effect is more common for those with darker skin). Again this discoloration is merely aesthetic and not dangerous in any way.
other possible side effects:
- Softening of cartilage at the site of the injection
- Weakening of tendons at the site of the injections
- Infection at the site of the injection (make sure your physician is always using alcohol/iodine to properly sterilize at the time of injection).
In Conclusion
To repeat myself just one more time, the newer, more synthetic, steroid anti-inflammatory medications are in our system for a much shorter period of time, making them much more attractive as a temporary pain-relief solutions.
So think twice before getting a cortisone shot, and consult your own doc!
Hope that helps!
Dr. Sterett
