The Truth about Cortisone Shots

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The stories regarding the dangers of cortisone come from years ago when it was first introduced and it was used in larger doses (the consequences were not yet recognized). Cortisone, in shot and pill form, is a valuable treatment tool for a wide variety of conditions. Many people have fears about its use, some of which may be justified. Today, with a careful assessment of the benefits, cortisone is a very useful and effective tool in any orthopaedic practice.
Glass Medicine Vials and syringeCortisone, in shot and pill form, is a valuable treatment tool for a wide variety of conditions.Learn More about Epidural Cortisone Shots

What is cortisone?
It is a hormone produced by a small gland on top of the kidney called the adrenal gland. It is essential to the proper functioning of your body, particularly when under stress. Its absence is known as Addison's Disease, which without treatment is fatal. Cortisone is a normal body product therefore; there are no allergic reactions. In cases of people with severe allergies, it is one of our most effective treatment tools. Cortisone by itself is rarely used today as it is relatively short acting and of low potency. Semi-artificial cortisone derivatives, such as DepoMedrol, Celestone, Kenalog, and a number of others, are used with increased benefits and fewer side effects.

How is cortisone effective?
Cortisone is useful in suppressing inflammation in the short term, and in the long term, dissolving scar tissue, stabilizing the body's defenses, speeding the healing process, and is very effective in causing certain cysts to disappear. It does however, have a weakening effect on tendons if injected directly into them. It can also soften cartilage when injected into a joint. (Information comes from experiments on animals and not human beings.)

How many injections are needed?
In spite of surrounding folklore, there is no specific limit to the number of cortisone shots that can be given. Practical concerns are, if the shot does not work, then why repeat it? If it does work, cortisone is extremely effective and not too many shots are needed. There is a limit to the amount of cortisone given in one dose, even if injected in several areas of the body; this varies depending on the size and physical condition of the person.

Commentary by Howard S. An, MD

This article on cortisone injections is quite informative and the information is accurate. Even though the success rate of epidural steroids varies among different studies, I generally agree with the author that cortisone injections can be helpful to treat pain and inflammation in many patients with spinal disorders. It also can serve to prevent surgery in some patients.

It should be emphasized that epidural steroids are indicated for patients with a herniated disc or spinal stenosis with radiating leg pain, not just low back pain. Cervical epidural steroids are more technical in nature and are not advised for patients with severe stenosis because of the risk of potential spinal cord injury. Although rare, epidural steroids also can result in epidural abscess. Other complications may include spinal fluid leakage and nerve root injury.

Finally, the patient should be informed about the temporary nature of epidural steroids. In general, cortisone injections serve to decrease pain and inflammation temporarily so that the patient can resume the rehabilitation more effectively. It is the combination of rehabilitation and cortisone injections that results in long-term improvement, not just cortisone alone. Even though cortisone injections should be part of the treatment options for spinal disorders, more scientific studies are needed to validate the specific indications.

Updated on: 06/26/18
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Types of Cortisone Injections
Howard S. An, MD
The Morton International Endowed Chair
Professor, Orthopaedic Surgery
Rush University Medical Center
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Types of Cortisone Injections

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