When it comes to the treatment of Tennis Elbow (link to overview of the topic), the Cortisone shot is the epitome of the apparent quick fix cure – It can often wipe away pain like magic, sometimes providing instant and complete relief in the short term – But at what cost in the long term?...
Research reveals that the powerful but often fleeting benefits of these steroid injections can come at a very high price in the form of lasting and sometimes very serious consequences in the long run (like significant tendon damage.)
Is the pain relief really worth it?... Does that relief have anything to do with healing the injury? – Or is it actually a mirage; a complete falsehood?...
(The video above contains a playlist of two episodes on Cortisone - The first being shorter and more recent - and the second a longer, older version containing more of the details you'll see below.)
Podcast Episode On Cortisone Injections
Here's a podcast version of the second, longer Cortisone Shots video above that you can download and keep by clicking the "download" link under the player below:
The Dark Side Of Corticosteroid Injections
Here are the key points you need to know if you’re considering getting an injection or if you’ve already had one or more:
- Cortisone shots are NOT an effective treatment for Tennis Elbow: They certainly don’t help your tendons heal (they only mask your symptoms),
- Not only are they ineffective at healing they can have the opposite effect; actually damaging your tendons – delaying your recovery by months or even years, (among other serious side-effect risks),
- Medical researchers have known about the damaging effects of Corticosteriods for decades, yet despite this fact, Doctors continue to give these damaging shots – often without informing you of the full risk involved.
These are well-documented, easy-to-find facts. Here’s a key quote about the shot's worst effects from a very often-cited paper I consider “The Bible” on tendon injuries:
"It is clear that, corticosteroid injection into tendon tissue leads to cell death and tendon atrophy. …[Cortisone injections] inhibit collagen synthesis and decrease load to failure"
So, Cortisone shots given directly into the tendon can cause cell death (self-explanatory, right?) and tendon atrophy, which simply means shrinking and weakening.
With this understanding they’re not supposed to inject it right into the tendon any longer, rather “around” it – but how much safer can this be!? (And does your doctor know this and follow it to the letter? How accurate can they be with that needle?)
Cortisone Shots: Worst Tennis Elbow Treatment Ever? (PIN this pic and warn your friends!)
And more importantly, do you really want a substance that has been shown to kill cells under your skin, around your tendon or anywhere NEAR it!?
As also noted, Cortisone can inhibit collagen production, which is another very bad thing because collagen is the protein that your tendon is made of, and you absolutely MUST be able to make more of it to repair and heal your tendon.
And “decrease load to failure,” is another way of saying the tendon is weaker and can’t handle as much stress or weight “load” on it - before it fails and possibly even ruptures (this has been know to happen, especially with athletes.)
I first discovered and wrote about this research in my ebook, 'Escaping The Tendonitis Triple Trap' over 15 years ago in 2003, when hardly anyone was talking about it.
The big, “MD-type” websites sadly still recommend the shot and perpetuate the inflammation myth, which we’ll get to, but it’s encouraging to see the truth about Cortisone going mainstream.
I was delighted to stumble on a post by Gretchen Reynolds, in the NY Times “Well Blog” asking…
“Do Cortisone Shots Actually Make Things Worse?”
This refreshingly direct article from The NY Times from 2010 begins with a brief look at the history of the cortisone shot, how it was lauded as a miracle-cure drug when first used in the 40s, and how it actually produced mixed and in some cases disappointing results in the clinical trials in the 50s.
NY Times Article: 'Do Cortisone Shots Actually Make Things Worse?'
That minor detail has, of course, done little to slow Cortisone’s meteoric rise to Pharma Superstardom and universal usage.
![Cortisone Shots For Tennis Elbow Treatment [Article: NY Times]](https://farm9.staticflickr.com/8488/8239254170_a3b3738417_o.png)
The author, Gretchen Reynolds cites a recent Lancet-published review of over 40 more recent clinical trials involving people with tendon injuries, mostly Tennis Elbow.
The review showed that in the short term it was clear that Cortisone shots did provide quick and significant pain relief – No surprise there.
But in the long term, 6 months to a year later, the people who had the shot were MUCH worse off than those who did nothing, especially those with Tennis Elbow, over 60 percent of whom suffered “a recurrence.”
(“Recurrence” sounds a little mild to me, but this is dry medical lingo. What I hear is: “The pain returns with a vengeance”)
Quoting the summary of the Lancet article directly:
"…Corticosteroid [Cortisone] injections reduced pain in the short term compared with other interventions, but this effect was reversed at intermediate and long terms."
The Lancet, Vol 376, Iss. 9754, 20 Nov. 2010, Brooke K Coombes, MPhty; Leanne Bisset, PhD; Prof Bill Vicenzino, PhD
Efficacy and Safety of Corticosteroid Injections and Other Injections for Management of Tendinopathy
Here’s another paper published two years earlier (which may be included in the Lancet review) saying basically the same thing, "No proof that they work."
"…Corticosteroid injections have been used for decades in the treatment of tendinopathy. [tendon problems like Tennis Elbow] There is strong evidence they relieve pain in the short term up to 6 weeks, but there is no evidence they provide any benefit in the long term (beyond 6 months)"
Treatment of Tendinopathy: What Works, What Does Not, and What is on the Horizon; Andres and Murrell – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2505250/
Now, switching back to The Times Article, here’s the kicker:
"Those people receiving multiple injections may be at particularly high risk for continuing damage…"
Dr. Bill Vicenzino, University of Queensland, Australia
This is something I’ve been convinced of for many years as a practitioner. I’ve treated many people with Tennis Elbow and have seen first hand (well, more like felt first hand) the damage done.
I believe I’ve seen the effect Cortisone has on the healing process. It stops it dead in it’s tracks. This is anecdotal, of course, and no kind of medical proof, but I can tell you the people who’ve had the shot (especially those who’ve had more than one) always take at least twice as long to recover – if they recover at all.
Update: Aug 25, 2016 - Another Cortisone Shot Study And NYT Article
The Cortisone shot came under fire again by Gretchen Reynolds this week, questioning the idea that it's a valid 'Quick Fix' for Tennis Elbow.
In the article, 'For Tennis Elbow, No Such Thing as a Quick Fix' (link below) she begins by affirming the continued popularity of the Cortisone shot as a Tennis Elbow treatment:
"Recent surveys in the United States and Britain show that injections of the steroid, ...are the preferred first line of treatment among many orthopedic specialists."
And then immediately raises the issue of the risks involved with these shots, referring to the:
"...growing evidence suggests that the injections, while effective in the short term, can frequently worsen the condition in the months that follow..."
Cited in the article is a study from Norway published in BioMed Central's Musculoskeletal Disorders Journal, which suggests that Cortisone injections, while effective in the short term for Tennis Elbow (in relieving pain) frequently worsen the condition in the months to come:
https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-015-0582-6
Isn't it sad and unfortunate to hear that Cortisone shots are STILL "the preferred first line of treatment" among numerous Orthopedists, considering this growing body of evidence suggesting they do more harm than good?
Not THIS one, apparently, though! Check out this video from an Orthopedist, frankly sharing his views on Cortisone shots here
And here's more evidence from more recent studies:
“Among patients with chronic unilateral lateral epicondylalgia, the use of corticosteroid injection vs placebo injection resulted in worse clinical outcomes after 1 year, and physiotherapy did not result in any significant differences.”
“Use of corticosteroid injections to treat lateral epicondylalgia [Newer term for Tennis Elbow] is increasingly discouraged, partly because evidence of long-term efficacy has not been found, and due to high recurrence rates.”
Effect of Corticosteroid Injection, Physiotherapy, or Both on Clinical Outcomes in Patients With Unilateral Lateral Epicondylalgia: Brooke K. Coombes, PhD; Leanne Bisset, PhD; Peter Brooks, MD, FRACP; et al - JAMA. 2013;309(5):461-469. doi:10.1001/jama.2013.129 https://jamanetwork.com/journals/jama/fullarticle/1568252
“CONCLUSIONS: Overall it is clear that the local administration of glucocorticoid has significant negative effects on tendon cells in vitro, including reduced cell viability, cell proliferation and collagen synthesis.”
“There is increased collagen disorganisation and necrosis as shown by in vivo studies...”
“This review supports the emerging clinical evidence that shows significant long-term harms to tendon tissue and cells associated with glucocorticoid injections.”
The Risks And Benefits Of Glucocorticoid Treatment For Tendinopathy: A Systematic Review Of The Effects Of Local Glucocorticoid On Tendon Semin Arthritis Rheum. 2014 Feb;43(4):570-6. doi: 10.1016/j.semarthrit.2013.08.006. Epub 2013 Sep 26. Dean BJ; et al https://www.ncbi.nlm.nih.gov/pubmed/24074644
("Increased collagen disorganization" meaning the tendon protein fibers are losing their strong, parallel alignment and becoming more random - And "collagen necrosis" means that the proteins are breaking down and degenerating - Rotting, essentially = Very bad results.)
Shockingly, collagen disorganization and necrosis/degeneration is the very essence of what's wrong with the tendons in most moderate to severe cases of Tennis and Golfer's Elbow, in the first place! (Known as Tendinosis, which we'll cover more about shortly.)
So, it appears that the steroid shots are making this worse!
So, What Is Cortisone And Why Is It Used?
Cortisone is the man-made / synthetic version of a Corticosteroid hormone called Cortisol that our bodies naturally produce.
The 'Anabolic' Steroids usually get all the attention and notoriety. They’re the "builder" hormones; they build tissues up, especially muscle.
And then there are 'Catabolic' Steroids, which is the class that Cortisone belongs to. These steroids have the opposite effect – They break your tissues down.
They are also very powerful inflammation suppressors and that’s theoretically why they’re used to treat Tennis Elbow and other 'Tendinopathies' (tendon conditions) but there’s a big problem with this idea…
Inflammation: Chasing A Ghost That Isn't There
There are two things you need to know about inflammation, when it comes to Tennis Elbow (and most other tendon conditions.)
The first is that most of the time there isn’t any! In other words, it’s not “Tendonitis” – (The ITIS suffix suggesting an inflammatory condition.)
“Numerous investigators worldwide have shown that the pathology underlying these conditions is tendinosis or collagen degeneration. One factor that may interfere with optimal treatment is that common tendinopathies [including Tennis Elbow] may be mislabeled as tendinitis. …An increasing body of evidence supports the notion that these overuse tendon conditions do not involve inflammation.”
Overuse tendinosis, not tendinitis part 1: a new paradigm for a difficult clinical problem. Phys Sportsmed. 2000 May;28(5):38-48 - Khan, Cook, Taunton, Bonar - https://ncbi.nlm.nih.gov/pubmed/20086639
The inflammation “story” is a tired, old myth and the Orthopedic-Surgeon authors of this second paper (and I suspect most of them in general) know the research and see for themselves no significant signs of inflammation in the tendons they perform surgery on:
“As orthopaedic surgeons, we are besieged by myths that guide our treatment of lateral epicondylitis, or "tennis elbow."
…The term epicondylitis suggests an inflammatory cause; however, in all but 1 publication examining pathologic specimens of patients operated on for this condition, no evidence of acute or chronic inflammation is found”
Lateral tennis elbow: "Is there any science out there?" Boyer MI, Hastings H 2nd; J Shoulder Elbow Surg. 1999 Sep-Oct;8(5):481-91 – ncbi.nlm.nih.gov/pubmed/10543604
The research clearly shows that most cases of Tennis Elbow (and other so-called TendonITIS cases) are degenerative NOT inflammatory. And they reclassified it as TendinOSIS decades ago – (See my article and video on Tendonitis Vs Tendinosis for more on this.)
What this means is not only do Cortisone shots “chase” something that probably isn’t even there, (inflammation) they risk making a problem that probably IS there worse.
Recalling that Cortisone is a ‘Catabolic’ Steroid; a steroid that breaks tissues down… And that Cortisone shots into tendon tissue can cause: “cell death and tendon atrophy,” and they can “inhibit collagen synthesis and decrease load to failure.”
What we seem to have here is a perfect recipe for worsening or outright causing degeneration and long-term weakness, pain and suffering.
Platelet-Rich Plasma?
If you're going to inject something, at least consider ProloTherapy injections or, better yet, Platelet-Rich Plasma therapy, which might actually encourage and kick-start a failed healing process - rather than suppress healing even further!
Or, perhaps consider Acupuncture - (article and video) - or Dry Needling - (article and video)
The other thing you should know about inflammation is that it’s a normal, healthy part of your healing process – At least when it comes to normal muscle and tendon healing.
I know I say this a lot, but it needs to be repeated and fully accepted: The simple fact is you can’t have healing and repair of your injured tendon without going through the inflammation process.
Tendons have a hard enough time healing without us trying to chase away with a dangerous drug one of the very things required in that healing process. Which leads us to the obvious question…
How do you support healing rather than getting in its way?
That’s what Tennis Elbow Classroom is all about.
Learn To Treat And Heal Your Own Tennis Elbow Or Golfer's Elbow At Home With This Video Program
You'll get instant access to a complete VIDEO program designed by a professional therapist to help you take charge and break your vicious cycle of pain and frustration!...
I'll be your personal tutor guiding you through step-by-step video lessons, where you'll get the therapy techniques, key stretches and essential exercises you need to treat and recover from your injury at home. (Without any special equipment.)
Tennis Elbow sufferers: Learn more about the Tennis Elbow course here
Golfer's Elbow sufferers: Learn more about the Golfer's Elbow course here
Hi, I have had tennis elbow for several years and have about two cortisine jabs per year. It has returned again and I am booked in for another jab today to tide me over till I get surgery. afrer reading your very informative article I have decided to take your advice. I am going to ask my Dr about “shock wave therapy” in the hope that will help.
Wow, Helen – That sounds like a lot of shots you must have had! Glad to hear you’ve decided to say “No Thanks!” to another jab, though. I wish you a speedy recover, but also must encourage you to be patient, as that many shots can significantly delay tendon healing.
(Unfortunately, in my experience, the damage seems to increase exponentially with multiple shots over time.) Hang in there!
I had tennis elbow about six months ago and was desperate to get it solved as I am an avid tennis player and do many other activities. I bought a special brace, theraband exercise bar, electric accupuncture and finally a cortisone shot. Completely healed… or so I thought. four months later it started to hurt again. Not much, but i could tell it was coming back. I did not know then what I know now about cortisone and was convinced to have one more injection. Disaster! Hurt a ton for the next two days but thought that was normal. Within a week I could see a valley forming on the back of my forearm caused by atrophy. Doctor sent me to physio, had fifteen sessions and was just getting worse. The pain is very different from the original tennis elbow, very specific, very sharp and very painful. Not only can I not do sports, I cant hold a cup of coffee, open a jar or do just about anything with my arm, which is starting to whither away from non use. (I use to work out 5 days a week). I am not afraid of hard work and will do what i need to get my arm back, but I fear I am going in the wrong direction. I think I am hurting it at physio and I recently read a post that some tennis elbow cases cannot be fixed after severe atrophy. Help!
Thank you for posting, Mike. That sounds terrible. I’m really sorry to hear you’re having such a tough time.
How large was that “valley?” Is it in your muscle or your tendon? That sounds like very dramatic atrophy. I’ve been doing a little researching and it looks like there are many more medical references to Corticosteroid-induced muscle atrophy (in many muscles at once) when it comes to taking the drug orally, rather than injection. (Atrophy refers to muscles – Tendon shrinkage is usually degeneration, from my understanding.)
The research I’ve seen on the long-term effects of the injections seems to focus on the damage to tendon it’s injected into or around, but it would seem to make that sense that local muscle atrophy could result from an injection (or more likely a series of them.)
I have seen one case in my practice where the person had a very bad reaction to the shot, and it caused a crater-like, crystalline-feeling depression (can’t seem to find the right term for this side-effect if there is one other than degeneration) in their tendon (but not the muscle connected to it.)
My thoughts on this is that despite the dramatic sudden onset of your muscle shrinkage / atrophy (if it is in your muscle and not your tendon!) muscles have a much, much larger capacity to heal and recover. So, I hope it’s muscular.
Hi, two days ago I had my second cortisone injection in my elbow in the past six months per advice of my orthopedic physician. After reading the research you provided, I regret my decision. My elbow feels better, but I have more tenderness this time around in the area. He suggested trying a PRP injection if this one didn’t do the trick. I just hope I haven’t already done irreparable damage.
I hit my elbow on the corner of my husbands dresser in the middle of the night. RIGHT below my joint above my forearm.. apparently right were people get tennis elbow.. I thought I just bruised it but it lasted for 4 months so I went to an orthopedic dr. He gave me a cortisone shot in March.. my pain returned about two weeks go, just got another shot today and it hurts WAY worse than it did the first time. I can not bend my arm up to my face or straighten it all the way.. I am sure it will feel better in a couple of days but I am assuming it hurts worse this time because I used my arm normally and did nothing to help it heal. He did mention surgery if it keeps flairing up…. scary!!
pain is what tells our bodies to stop using that area or rest it until the pain subsides which usually means until it has time to heal, taking that pain away removes that ALERT to rest or not use it, thus, no healing.
We have to remember, when we get these cortisone shots it is up to us to think, and rest and not use that area of the body for some time, just as if the pain were telling us to/
I have been suffering for 9 months with cronic tennis elbow. So far I;ve had 2 physio treatments lasting 8 months
and 1 cortisone injection. I was re-assessed yesterday and the doctor is recommending another cortisone
injection which I am going to refuse.This is not an easy decision for me as the Workers Safety Insurance
Board here in Canada will probably cut off my funding. The first injection I had did nothing to help my
condition and I feel another injection is just plain stupid. i am contacting my family doctor to get a referal for
a sports injury specialist to get a second poinion. I feel that the Canadian health system is way behind other countries in dealing with tennis elbow injuries. My research into Platelet Rich Plasma injections has me
convinced that this would be a better option for me. The problem is that this treatment is not recognized by
the Canadian health system and will not pay for it. it is my opinion that more research is needed to determine
a better method for the treatment of tennis elbow in Canada as cortisone is not the answer.
I have been suffering from tennis elbow for the last three months, it has been very painful, even to blow my nose, hold a cup of coffee, etc. I am receiving teraphy right now. Since I have not improved yet, today the Orthopedic doctor injected me with two injections of steroids (top and bottom part of elbow), I am having tremendous pain in the right arm and elbow area and do not know what to do. I do not know if I could take a pain killer. I cannot get hold of my doctor. I am getting for a nite of pain. Any suggestions?Can you reply? It will be very much apreciated.
Hi Elba, I’m sorry to hear you’re in so much pain from something that’s only purpose is to “relieve pain!” (I’m afraid I can’t offer any suggestions, though.) All the best to you.
My son had some elbow issues this season in football throwing he had to miss three games. Now he is able to throw and has no pain but his arm is still bent. Is this normal for recovery or should we be doing something, he is stretching and massaging it and he wants to play basketball but Im not sure about it??
Heidi, I don’t think I can make any recommendations to you, except to say that a bent elbow isn’t normal. Something is still wrong.
I had a rotator cuff tear. Got kenalog injected into my left shoulder…the tendon sheath to be exact. Six months after the injection i am still experiencing side effects. I had a period for 40 days straight. Hair loss that still continues, steriod psychosis, atrophy…everything you name it. I went to 5 doctors all of them told me i was just stressed out and one even offered me more kenalog. Im now getting surgery bc ive lost my range of motion and am so weak it hurts to put my shirt on in the morning. This stuff is poison and im glad someone realizes cortisone is bad and not the miracle drug docs claim it to be
If anyone would like to talk about my experience or share yours feel free to email me
Sorry to hear you’ve had such a tough time, Jennifer. I wish you all the best with your surgery. Hope you get your range of motion back.
I started your program today hoping to get better soon. I have been lifting weigths for 15 years and all my prior minor injuries have been at the elbow tip which have been told by my orthopedic surgeon was a bursitis. Afrer Celebrex and rest it finally got better and I was able to resume weight lifting for 1 year, but now comes this new injury that was told by the same orthopedic surgeon that was a lateral epicondilitis (tennis elbow) I have had my tennis elbow for 2 months and have been taking Celebrex on-off combined with totally been off exercising with weights for 2 full months without much sucess. He then suggested a cortisone injection when I complained of persistent pani. I got scared of this therapy so decided to consult a physiatrist. She ordered a elbow sonogram that revealed a 8 mm interstitial tear at the tendon area just were it reaches the lateral epicondile so the diagnosis was correct but she does not like steroid shots for the same reasons that you mention in your web site and videos. She told me to use Celebrex daily for 10 days and gave me exercises very similar to your web site as well as stretching. She also recommended a portable TENS UNIT and physical therapy with sonography and gels. Here is the thing. She told me that if I dont get better in 6 weeks instead of steroid injection she has had good results with dextrose injection (Prolotherapy) . Do you have an opinion on this dextrose injection? She says sugar is less likely to cause the bad rap of the steroids. She says sugar WILL CREATE an inflamation rather than decrease inflamation and that this will help better than steroids. Here is a link for a site I found: http://www.ncbi.nlm.nih.gov/m/pubmed/23291605/ Your response woud be apperaciated on this therapy.
Sounds like you have a sensible Physiatrist, Victor.
I like the theory behind Prolotherapy (Thanks for the link to the study. I hadn’t seen that yet.) but it’s still an injection. I’m sure you’ve done some searching for yourself on it and have found that people sometimes have bad reactions to it – even though it’s a totally benign substance.
I’m not about to tell you what to do, but I will say that I wouldn’t do it myself unless it was a last resort. (Glad to see you joined as a member – Thank you and welcome to Tennis Elbow Classroom! I’ll be looking forward to hearing about your progress.)
Thank you so much. I had pain in different parts of my elbow since last May. This morning and to my sorrow my elbow specialist just gave me a Cortisone injection. I was actually improving with physical therapy but the progress was very slow. Should I expect my case to get worse now and my tendons become weaker. Will I be able to go back to weight lifting? My Dr. didn’t mention any of the side effects of a cortisone injection.
Also would PRP fix this mess the cortisone creates. I can’t believe that Drs would do something that make your case worse. I am honestly freaking out after reading all of this negative reviews.
PRP sounds good in theory to me so far. Definitely moving in the right direction toward supporting and stimulating the healing process – and away from just “symptom suppression at the expense of healing!” (which is what I think of as the very essence of Cortisone.)
Mina, I’m sorry to hear your Doctor didn’t mention anything about the downside of Cortisone. (It seems they seldom inform people – I wonder how many really know about all the medical studies.)
I have no way of knowing if your tendons will get weaker – but the upside is that it was only one shot, right? (It’s the multiple injections over weeks/months that seem to have a cumulative, negative effect.)
I would try to put it behind me, if I were you – You didn’t know any better and had no opportunity for ‘informed consent’ – so, all you can do is make your decision about whether to have any more shots (I’m guessing, no? ! ) and do your best to move forward and support your healing process.
I don’t see any reason why you wouldn’t be able to get back to weight lifting (you’ll have to be careful, of course) but to help you with that question I would definitely suggest my post and video: Can You Still Work Out When You Have Tennis Elbow?
Alright, I think it was last year in October when I was trying to build muscle. I didn’t know the risks of lifting too much, so a few days later I started having pain in my elbow. The pain progressively for worse until it was unbearable to even bend it. So my doctor have me pain pills and told me to put ice on it. My arm seemed to get better with that treatment, but when my pills ran out it went right back to where it started. Later I found out that I couldn’t bend my arm past a 85° angle and it wasn’t because of the pain. So, I went and got a cortisone shot with another fast-acting pain reliever (it was something with the suffix CANE) Well, the “fast-acting” pain reliever didn’t work at all but after a three days the cortisone kicked in. I could extend my arm fully and there was relatively no pain.
Right now there’s still little to no pain, but I’m wondering how long it will last and how I can start to repair the damage, or at least prevent any more damage from happening.
Also, when I got the shot my doctor went around the tendon instead of injecting it, but I’m not sure if that’s better or worse.
Thank you in advance.
If you’re having significant limitations fully flexing and extending your elbow (especially mechanical limitations, and not due to pain) then it sounds like you may have more going on then simply Tennis Elbow, as in injuries to other muscle/tendons or perhaps even your elbow joint capsule itself, which I’m afraid I can’t do justice to addressing here. I would strongly recommend that you seek out one-on-one expert help from a therapist in your area.
I had one steroid injection last year as the g.p didn’t know if it was my fibromyalgia or I had got tennis elbow. I was in total agony with both elbows, I was sent for steroid injections in my left elbow. And told it may discolour a bit of the skin. To my horror now that it is the size of a 50p and I have shrinking atrophy. Basically I have no tissue at all under the injection site. It is very painful to lie on as I have Fibromyalgia and terrible indentation to where the tissue was.
I was thinking of trying to claim compensation for this as it looks so ghastly.
Louise
I’m so sorry to hear you had that happen from the shot, Louise. (It’s not all that common – I’ve only seen it in one person – but it happens and it’s well known in the medical literature!) All the best and good luck to you!
Hi Alan,
Firstly, I just want to say thank you for doing what you are doing – putting in a very sincere effort towards a little known problem area that affects many!
I just came across your site today and have spent the last few hours watching a lot of your past videos and I must say, you have hit the nail on the head in terms of understanding the issue – something that the orthopedic surgeon I’ve been seeing hasn’t.
I’ve had golfer’s elbow on & off for some years now and on that basis, the orthopedic surgeon recommended a cortisone injection, which I obliged with, not knowing the risks at the time. One year hence, I am in more pain than I was prior to the injection and he claims that it is an “unusually rare” scenario as most people heal completely within 3 months of the injection. I was desperate for pain relief but now very much regret the decision to do so without having done thorough research prior.
My question is – through your years of experience with patients/students – have you seen the negative effects of a single cortisone injection reverse over time and eventually heal?
Thank you.
I hope the doctor replies as this is something my partner is struggling with.
I’m not actually a Doctor but what is your question?
My question is – through your years of experience with patients/students – have you seen the negative effects of a single cortisone injection reverse over time and eventually heal?
Sure! All the time. It’s when you get into multiple shots – especially 3 or more – that it seems to have an exponentially negative effect. Try not to lose sleep over it if you’ve only had 1 shot.
Hi Allen. So approximately six weeks ago (I wish I had seen your article sooner!) I visited an ortho doctor and ended up with a shot in both elbows. After reading this, of course, no more shots for me! I’m very much into alternative medicine and had no idea how damaging this could be and I’m kind of freaked out realizing what I allowed to be put into my body and I seem to be having side effects already! I noticed over the last 2 weeks that my pigment has faded (I’m Caucasian and didn’t realize I’d lost my pigment in my elbows until I got some sun) , there looks like little white “polka dots” under my skin on the backside of my elbows, and there are little “indents” where it looks like there is some atrophy under the skin going on… one of my elbows has what looks like the beginning of a rash or some little bumps that are raised, and one of my elbows has like a kind of burning/scratchy feel and the skin is super dry where my pigment has disappeared. Both of my elbows are red. Thoughts? This seems like a LOT going on for just one shot! 🙁
Really looking forward to your reply.
Sorry for the late reply, Kay! The reaction you’re having is not very common, but it happens and I’ve seen it in a couple of my clients. I don’t know if there is anything you can do about it. Maybe a Dermatologist will know. So sorry to hear that happened to you. All the best!
Why would cortisone shots and anti-inflammatory drugs take away the pain if there is no inflammation present? I don’t understand that? How would they help if there is no inflammation present?
These drugs work on multiple levels for one thing. They are “Pain Killers” as much as anything. Cortisone is so powerful, it suppresses so much of the metabolic / cellular activity in the area that it can “deaden” it. Sadly, by knocking out the Stem Cells in the tendon (Tenocytes and Fibroblasts) your tendon can’t adequately heal and regenerate.
And it’s also not necessarily that there is NO inflammation present. (There can be some in the early stage of a tendon disorder)
What I’m always trying to get across is that any inflammation that IS present is not the issue at hand – Not the cause – Not the problem, because it’s part of your body’s attempt to heal your tendon.
I had a cortisone shot in January. Pain was excruciating right after injection & was taking my breath away and then I got hot flashes for the next couple hours.
3weeks later, this skin over my elbow was white, and it had eaten away at the tissue, was left with just a thin skin layer over the bone & pain returned. Did an MRI & I had a torn tendon & it was ripped off the bone.
Went in for surgery March 21. Had the torn tendon repaired & the surgeon attached the tendon to the bone using the anchor that he drilled into my bone. 3 weeks after surgery, my incision opened, surgeon told me to put a bandaid on it. I was leaking senovial fluid out of my elbow in large amounts. Went In for surgery again may 5th. Surgeon said my surgery was blown to pieces & nothing took from the 1st surgery and I developed a hole in my joint. He cut a muscle & stuffed it into the hole in my tendon.
Went today for my 1mo f/u. Still having extreme pain, swelling in arm & stabbing sensation as well as super sensitive skin around the incision.
Surgeon recommend another MRI & stated I may need a 3rd surgery to clear out fluid $/or scar tissue in my joint that is not allowing me to straighten my arm.
Is this normal? I have been babying this arm for months & none of this makes sense to me!