Millions of Americans experience what's commonly called "tendonitis" due to overuse, injuries, aging, or just plain wear and tear.  Often, their trip to the doctor results in a quick fix-a shot of corticosteroids (or "cortisone") to reduce inflammation and pain.  Most patients experience almost immediate pain relief from cortisone shots. Unfortunately, it doesn't really solve the problem that caused the pain, and eventually the pain may come back. Corticosteroids also have side effects, so are these shots really a good idea?

Tendons are strong cord-like, fibrous tissues that attach muscles to bones.  The suffix "itis" means inflammation, so tendonitis means "inflammation of the tendon."  That may be a misnomer, however, as scientists now say common conditions like tennis elbow, rotator cuff, and Achilles tendon pain are not really caused by inflammation, but by fraying or degeneration of the tendon. Many physicians are now using the suffix "pathy" which means "disease process" and call these conditions tendinopathies.

Tendinopathy can be painful and limit range of motion.  Treatment options usually include physical therapy, ice, heat, rest, time and very often, a shot of cortisone. With cortisone, the pain goes away quickly and stays away for four to eight weeks.

Researchers recently published in the medical journal The Lancet, a systematic review of randomized trials to establish the effectiveness and safety of cortisone injections for tendonitis/tendinopathy.  They found that while these injections were effective for short-term pain relief, patients who used them had worse outcomes for complete recovery of their injury in the long term.

Professors at the School of Human Kinetics at the University of British Columbia discovered that patients who took a more conservative "wait and see" approach to healing and did not use cortisone injections usually recovered fully within six months.  Those who did use the shots were re-examined at six and twelve months and found to have significantly lower rates of full recovery and a 63 percent chance for relapse. Instead of helping them heal, cortisone shots actually impeded healing.

Local cortisone injections usually have very few side effects, though infection, change in skin color at injection site, increased bleeding, and tendon damage can occur. People with diabetes may experience increased blood sugars and those with compromised immune systems may experience even more immune deficiency. Long-term corticosteroid use is associated with a long list of serious side effects and complications.

So, why would people use cortisone injections for tendonitis? Even though studies now show those "miracle shots" may do more harm than good, many patients still want them because they effectively relieve pain. They prefer a quick fix instead of a more effective, but more uncomfortable route of physical therapy, rest and time. Many patients receive multiple injections over time and were found to have a 57 percent worse outcome for recovery than those who used only one.

If you're experiencing a tendon injury, talk to your doctor about physical therapy and other methods to support healing.


The Lancet, Early Online Publication, 22 October 2010

Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials Brooke K Coombes MPhty a, Leanne Bisset PhD b c, Prof Bill Vicenzino PhD - ceaff10