The indications for cortisone injection are primarily to reduce the pain of chronic inflammatory conditions like bursitis, tendinitis, tendinosis, trigger points, entrapment syndromes (carpal tunnel syndrome), and fasciitis.
While the injection may reduce the pain, it is a temporary solution unless it is determined what caused the inflammation to begin with. If the cause is not found and treated, the inflammation will return and the cycle of pain will continue.
Cortisone Injection Needs to Be Used in Conjunction with a Treatment Plan
A cortisone injection may be effective as a quick fix, but it is usually not a permanent solution to the problem. And if it is used, according to the American Academy of Family Physicians, the cortisone injection needs to be used in conjunction with a treatment plan and not used as a stand alone treatment (Joint and Soft Tissue Injection, July, 2002).
Because cortisone can mask the underlying injury, care must be taken to obtain a comprehensive medical history to ascertain the cause of the initial injury. Bursitis, tendinitis, and carpal tunnel syndrome are all injuries of overuse.
Overuse injuries are caused by repetitive motion. Inflammation occurs when the demands of the activity exceed the strength of the tissue. When this occurs, the tissue becomes inflamed and painful.
Treatment for tendinitis includes calming the inflammation through rest followed by progressive strengthening to rebuild the strength of the involved musculotendon area. When this is done correctly, the patient can return to activity with no pain and with a stronger tendon.
Absolute and Relative Contraindications
One of the contraindications for cortisone injection is injecting into a tendon site that is at high risk for rupture (weightbearing tendon such as the achilles). The reason for this is that repeated cortisone injections can actually weaken a tendon making the tendon susceptible to rupture. A weightbearing tendon has to resist more force (due to the mass of the individual) thereby any weakening of the tendon can make it at risk for a rupture.
Other absolute contraindications for cortisone injections include drug allergies, infection, fracture, or disease at the injection site (Joint and Soft Tissue Injection, July, 2002).
Relative contraindications (should be considered on a case-by-case basis by the physician) include diabetes and hypertension. According to the American Orthopedic Society for Sports Medicine (2008), cortisone may cause a significant elevation in blood sugar levels for 3-5 days after the injection due to the release of cortisone into the bloodstream. Diabetic patients need to monitor their blood sugar levels closely for several days.
Hypertensive patients need to be aware that cortisone injections may also cause a temporary increase in blood pressure (Cortisone Injections, August, 2008) as posted on the Sports Medicine Network website.
Multiple Injections
According to Cardone, D., and Tallia, A (July, 2002), “therapeautic responses to corticosteroid injections are variable.” The patient’s response to the first injection is an important indicator in determining if there will be a successful reduction in pain in future injections.
Patients who have not gained relief after two injections should “probably not have any additional injections, because a subsequent positive outcome is low” (Cordone, D. & Tallia, A, July, 2002).
The American Orthopedic Society for Sports Medicine recommends no more than three cortisone injections within one year. If pain relief lasts less than three months after a cortisone injection, different therapy should be persued.
Terry Zeigler - Educating through writing with over twenty-five years of experience as a Kinesiology Professor and Certified Athletic Trainer.
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