A Look At Cortisone Shots For Tendonitis And Fasciitis

Cortisone shots are one of the most frequent options that doctors turn to when they are faced with patients complaining of tendon or fascia pain. But do they genuinely work?

I'll address that question in a moment, but first let's talk about cortisone itself. Cortisone is a hormone produced by the adrenal gland. It is technically a cortico-steroid (not to be confused with the anabolic steroids that bodybuilders often use), and it is crucial for maintaining proper function of your body. Virtually every human being on the planet produces it naturally, so questions of allergies and so on aren't relevant.

Most "cortisone" shots, however, have very little pure cortisone in them. Derivative compounds, like Kenalog and Celastone, are more widely used because they have advantages like longer potency and fewer side-effect complications. Also, there is typically a pain reliever included in the shot. So if you're one of those people who has an allergic reaction to the injection, it's probably due to the pain reliever, not the cortisone derivative.

Cortisone can, and often does, work to reduce inflammation for a few days. This might make you feel better for a little while, but when the effect of the shot wears off (and it will, all too soon), the pain will come back with a vengeance if you haven't taken care of the underlying tendon problem as well. Also, there is a limit to the number of shots that can be performed within a set time period, since animal studies have shown that cortisone can weaken tendons and cartilage in joints when over-administered via localized injections. (Cortisone that is taken orally, which is more evenly dispersed over a longer period of time, doesn't incur this problem.) The potential for damage is especially troubling in young people, due to the fact that their connective tissues are still healthy. Anyone under the age of twenty-five or so should be sure to try other forms of therapy first. People who are older and thus as a rule have joints with significantly more wear-and-tear, don't need to worry as much. Also, certain tendons - the Achilles tendon in particular - are prone to rupture even when the injections are performed with the utmost care.

Inflammation, while often a useful physiological reaction, can actually impede healing when it is present in excess. The idea behind a cortisone shot is that by helping to suppress unnecessary inflammation, it will thereby aid in healing. However, the most recent medical studies are increasingly showing that tendonitis, RSIs (tennis elbow, runner's knee, carpal tunnel syndrome and related conditions suffered by data entry professionals), fasciitis and the like are not actually caused by inflammation, but by some other mechanism -- the most likely culprit being direct damage to, and/or fraying of, the fascia or tendon. This, of course, calls into question the entire rationale for the shots in the first place.

So why do patients report a decrease in pain? For starters, not all do - cortisone shots are reported as being effective in only about 50% of the people who receive them. For those that do experience relief, the most likely explanation is that the analgesic included in the shots has a temporary deadening effect on the pain. Of course, the placebo effect is always present as well.

While cortisone shots are a very effective treatment for certain conditions such as arthritis in older patients, there are serious questions as to their effectiveness when it comes to conditions like tendonitis, fasciitis, tendonosis, fasciosis and the like. Especially with younger patients and runners who suffer from Achilles tendonitis, it seems that there are more efficacious tendon pain treatments available. Ones that have a higher cost/benefit ratio and far better success rates. The shots do have some points to recommend them, of course. They're fast, easily administered, and fairly economical. They also fit pretty well into systems of therapy that deal with symptoms rather than root causes. Finally, many doctors prefer them due to the ease of monitoring their use. But when you consider the discomfort of receiving an injection directly into damaged tissue, the questionable mechanism by which it is supposed to work, the coin-toss percentage of patients who report even temporary pain relief, and the possibility of potentially severe side effects, it makes sense to try other treatments first.

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