If people have had an injection for a painful knee (for example), they may have had one of 3 responses: (1) no improvement (2) short term improvement (3) fantastic improvement…it cured my problem.  

So why the varied responses?  Well, this can be due to a number of reasons.  Firstly, was the injection accurately placed?  We know that the more accurate an injection is, the more likely people are to have a good response.  However, even a well-administered injection may not provide any benefit if it is not the most appropriate treatment for the condition.  Broadly speaking, steroid injections work best in a local inflammatory situation, so if there is no inflammation it is less likely to work.  Sometimes people have a short period of pain relief following injection for pain to return thereafter.  In this instance, it could be due to failure to address an underlying cause for the inflammation.

The other, justifiably, talked about issue with cortisone is the potential degenerative effect it can have on joints and soft tissues.  Just as steroid injections can help to remove inflammatory cells, they can also negatively impact on healthy cells such as cartilage or tendon cells.  Historic studies have shown that repeat injections, often of quite high doses, can contribute to the development of joint problems such as arthritis, and in weakening of tendons.  These days, contemporary practice limits both the dose per injection and the total number of injections permitted.

So where does this leave us now?  Do we still inject cortisone? Well…yes! It does still have a place in many situations.  It is a great treatment for lots of conditions if used appropriately such as Frozen Shoulder, tendon sheath problems of the wrist and hand, and even within joints.  For some people with severe inflammatory joint or soft tissue pain, often there is nothing better at providing some welcome relief than a steroid injection.