Even more warnings about the dangers of cortisone injections

Here is an example of the damage that can happen from a single cortisone
injection for "Tennis Elbow" several months later.  This woman
is left with very thin de-pigmented skin over a diffuse area
and loss of protective fat.

I have written more than a few articles about the dangers of injecting cortisone into body parts, like tendons, ligaments, joints and muscles.  Have a read here of one of my earlier warnings about these harmful injections.  The photos look very similar to the ones in this article don't they?

And here is the search string for a whole lot of articles I have written about cortisone injections.

These injections can leave their victims suffering from visible deformities and ongoing structural weakness, including catastrophic rupture of muscles and tendons.  These are not theoretical or rare - these are common side-effects of a surgical procedure that is enthusiastically promoted as the "quick-fix" panacea of all musculo-skeletal aches and pains.

Give me a shot doc

The protective fat of the elbow has been lost, exposing the
bone, tendons, nerves and ligaments to injury from
bumping.  It is visibly unsightly.  This skin damage and loss
of protective cover will become more and more of a
problems as she gets older.

 How come?  Here is my speculation as to why (excuse me if the following comes across as being a bit cynical):

• It is a surgical procedure that wannabe surgeons who never quite made the grade can employ.
• It is cheap, quick and easy to perform with a very good rate of financial return for the administering doctor.
• It fits with the criteria for most medical procedures of today - Fast Medicine!

The adverse reactions to these injections are grossly understated.  Why?

The site of the "tennis elbow" that was injected was the wrong spot!
So, several months later, she still had elbow pain which has now
resolved with some firm deep tissue massage.

• Because the adverse effects such as deformity and tendon rupture may not be obvious, or happen until several months later.  By which time the injury may not be linked with the cortisone injection.
• The doctor who caused the harm may be reluctant to acknowledge the link and even less reluctant to report it to officials (Less than 10% of all adverse medical reactions ever get reported: Some cynics believe the true figure to be less than 1%).
• The drugs company that supplied the cortisone may dispute any attempts to link the procedure with cases of harm.
• Accident Compensation is the master at wiggling out of injury claims.  It does this by hiring medical experts who are expert at turning real injuries into fictional degenerative processes.
• The patient usually does not have the nous, the time, nor the energy to take a case through to acceptance.

This woman needs a skin graft and fat injections.  She
is hoping for a successful ACC claim to cover
these procedures.  My advice to her is not to hold
her breath!  It will be interesting to see how she gets on.

My advice if offered a cortisone injection is this:

Say "No!"

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About this website

The advice in these articles is given freely without promise or obligation.  Its all about giving you and your family the tools and information to take control of your health and fitness.

Auckland University Study finds steroid treatment beneficial - Updated

Steroid treatment for osteoarthritis knee suffers was thought to progress the disease, but that belief has been overturned following a review of the literature by researchers at The University of Auckland.
Associate-Professor Bruce Arroll, from the School of Population Health at the University, says that osteoarthritic knee pain is one of the leading causes of disability amongst older people.

Photo: Example of the devastation that can be caused by cortisone injections

"Previously it was thought that you could give sufferers about 20 mgs of the steroid cortisone (prednisone) for a couple of weeks, but that it promotes disease progression if it is used any longer."

"From reviewing all the hospital-based research, we have found that there was no evidence that cortisone progresses the disease. In fact, it provides an effective pain relief for up to five months particularly if the dose is increased to between 40 and 120mgs," Dr Arroll says.

There is no cure, other than surgical joint replacement, for knee osteoarthritis, but Dr Arroll says the study gives hope of pain relief for sufferers.

"Our finding that giving steroids is effective for longer periods means that knee replacements won’t be needed so urgently. The injections will enable people to walk, be more comfortable and have less trouble from their knees," he says.

The study, commissioned by the Accident Rehabilitation and Compensation Insurance Corporation, was co-authored by Dr Arroll and Dr Felicity Goodyear-Smith from The University of Auckland and was published this month in the British Medical Journal.

Dr Arroll says surgeons and doctors are already showing an interest in the work.

"Another concern that was raised in the past by surgeons is that treatment could weaken the joints and therefore make joint replacement surgery less effective. But none of the research supports that, so it seems that cortisone will not have a negative effect on later surgery," he says.

Dr Arroll says it is the first time a review of research into cortisone treatment for osteoarthritis of the knee has been undertaken. He says future research into the area is needed, which would include longer studies that look at the impact of higher doses of cortisone.

Please read this article below from Complete Fitness
"How do cortisone injections work?
Cortisone is a powerful anti-inflammatory medication that occurs naturally in the body to controls and assists normal body functions. When therapists use cortisone to treat tendonitis, bursitis, and arthritis it acts as a potent local anti-inflammatory drug. 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.Cortisone is not directly a pain relieving medication, as it only treats the cause or site of inflammation. Your pain is decreased by a cortisone treatment because the inflammation is diminished and this is turn reduces the pain. By injecting the cortisone into a particular area of inflammation, very high concentrations of the medication can be given while keeping potential side-effects to a minimum.
What is cortisone?Cortisone is a type of steroid that is produced naturally by a gland in your body called the adrenal gland. Cortisone is released from the adrenal gland when your body is under stress, and natural cortisone is released into the blood stream and is relatively short-acting. The absence of cortisone in the body is called Addison's Disease.Injectible cortisone is synthetically produced but is a close derivative of your body's natural product. The most significant differences are that synthetic cortisone is not injected into the blood stream, but into a particular area of inflammation. Also, the synthetic cortisone is designed to act more potently and for a longer period of time (days instead of minutes).
Are there side effects to a cortisone injection?Unfortunately yes. Probably the most common side-effect is a 'cortisone flare,' a condition where the injected cortisone crystalizes and can cause a brief period of pain worse than before the shot. This usually lasts a day or two and is best treated by icing the injected area. Another common side-effect is whitening of the skin where the injection is given. This is only a concern in people with darker skin, and is not harmful, but patients should be aware of this. Other side-effects of cortisone injections, although rare, can be quite serious. The most concerning is infection, especially if the injection is given into a joint. The best prevention is careful injection technique, with sterilization of the skin using iodine and/or alcohol. Also, patients with diabetes may have a transient increase in their blood sugar which they should watch for closely. Because cortisone is a naturally occurring substance, true allergic responses to the injected substance do not occur. However, it is possible to be allergic to other aspects of the injection, most commonly the betadine many physicians use to sterilize the skin."

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Gary Moller comments:
These articles completely underplay the dangers of cortisone injections while overplaying their benefits.
While there may be some benefit for advanced cases of osteoarthritis, I do not think there is any place at all for mild cases and definitely not for young people.

I am always wary of research that comes out with results that confirm the status quo while going against what I see happening in the field. Please read my earlier articles on this subject.

Photo: another example of the permanent damage and disability that can be caused by cortisone injection (These injections were done by experienced sports medicine physicians)
The mechanism of cortisone is not adequately explained in most articles on the topic. Cortisone is a form of chemical excision and this can be more indiscriminate than a scapel. The side effect of skin blanching (whitening) that is described shows what is happening deep in the area that was injected: the blood flow to the area is shut off, causing tissue death. This is why there is the risk of tendon, ligament or muscle rupture following these injections. That these terrible side effects are not officially reported as often as they are known to happen is par for the course. Adverse medical reactions are seldom recorded with the reported rate being less than 10% by some estimates.
Why is there such a paranoia about inflammation? Have you ever wondered why the body in its wisdom invented inflammation? Inflammation is a natural healing process that one is advised not to interfere with, either by drugs or by excessive use of cold. Inflammation happens when the body pumps blood and nutrients to the damaged area and the cells that remove the damage and rebuild healthy tissue proliferate. If we interfere with this natural process, we do so at the cost of proper healing. We end up with weak tissue that will tear with the first application of strain. Such is the consequence of the ignorant application of drugs and other misguided therapies.

What these articles fail to tell you is that there are excellent alternatives. But these alternatives are unpopular. Is it because these are non-drugs therapies which take time and for which there is no profitability for the professionals being consulted?

The alternatives are remedial exercises, nutrition and deep tissue massage. Done correctly and given time, these encourage natural healing processes, including supporting the natural healing powers of inflammation, rather than suppressing it.

If you are considering cortisone injections for a chronic injury and want to better explore the possible alternatives, contact me.

A fresh warning about the dangers of cortisone injections

I continue to receive inquiries from people who have had cortisone injections to treat injuries to joints, tendons and ligaments, or have recommended that they undergo such treatment. This type of treatment remains disturbingly common and the consequences can be catastrophic.

Photo: Example of chemical excision by cortisone injection causing permanent damage to the ankle joint (note the large indentation where the lateral ligaments of the ankle once were). Only one injection is required to cripple the recipient.

Cortisone is a form of chemical excision. It kills living cells, dissolving living tissue, killing off everything it has contact with. While the relief from pain may be immediate and lasting, the adverse consequences may not appear for weeks or months or even years later. The consequences may be the catastrophic snapping of a tendon or muscle, loss of protective ligaments or the loss of protective cushioning tissue, such as that found in the heel pad. While many people get away without apparent long term consequences, I can tell you that many people definitely are not so fortunate.

Why is it that cortisone continues to be used to widely and for so many different musculoskeletal problems?

• It is cheap, quick and easy and can be done in any medical consulting room
• Relief from pain is instant and it tends to lastJust 1-4 injections seem to do the job which is usually much better and quicker than one would get than other therapies like physio
• If there are any catastrophic consequences, the association with the cortisone injections may never be known and the injecting Dr will never be any the wiser

When a Dr tells you the "risk is 1/1000" bear in mind that this estimation may be based on worthless stats that do not take account the dozens and dozens of unreported adverse side effects that run parallel to each reported case!

If you have an injury that fails to respond to rest and/or medical treatment, or are bothered by chronic pain and treatment with cortisone has been recommended, you are welcome to write to me and I will do my best to assist with helping you with deciding on what is the best course of action to take.

A health warning about the use of glucocorticoids, including asthma medication

In a recent newsletter, sports medicine expert, Dr Gabe Mirkin, discussed findings of a study which found unusually low bone densities in professional cyclists.  It is now his opinion that this may be due to the abuse of drugs such as prednisone, cortisone and asthma medication (glucocorticoids).  (I have copied the section of Dr Mirkin's article and a link to his site at the end of this article).

While these drugs may enhance performance, the down-side is calcium is driven out of the bones and into the circulation, including soft tissues.  This is seen in a hair tissue mineral analysis as elevated calcium and on a bioelectric impedence analysis as low bone mass (This is measured using the Salter 9106 Scales).

My main concern is for the hundreds of thousands of ordinary New Zealanders who are unwittingly taking these steroids and not aware of the serious long term damage.  Prednisone and cortisone are without doubt the most harmful in terms of speed; but "mild" versions, including "preventer" asthma medication, causes untold damage to health, much of which may not be apparent until decades later.  The damage I see includes:

• Osteoporosis.  Sometimes apparent less than 30 years of age.
• Joint arthritis.  Some cases requiring joint replacement.  Some cases less than 30 years age.
• Constant bruising.
• Constant muscle tears sprains and strains.
• Fragile, thin skin.
• Premature ageing.
• Poor healing.
• Extreme fatigue, including "brain fog".
• Fibromyalgia and Polymyalgia.
• Cardiovascular disease due to calcium deposition in the blood vessels.
• Digestive disorders.
• Weight gain.
• Fluid retention, lymphoedema.
• Emotional fragility, including depression.

There are solutions which include careful weaning of a person off these steroids.  Cortisone is produced by the adrenal cortex.  Incidentally, the adrenals produce more than 90 different steroidal hormones.  It is very arrogant for us to believe that we can do better than these amazing glands by bombing the body with synthetic variants.  Weaning a person off steroids focuses on restoring healthy adrenal function.

For detailed information about adrenal function, go to www.adrenalfatigue.co.nz and then get hold of me if you need help.  I am a registered practitioner with this organisation.

Dr Mirkin's article and website link are below...

Was David Beckham's Achilles tendon rupture the consequence of one cortisone injection too many?

"Beckham stepped onto Qwest Field in Seattle with a trio of cortisone injections in his right ankle in an attempt to dull the pain of severe bone bruising. By the end, the effects of the shots had long since worn off and he was effectively a passenger, hobbling and aching."

Reference:  "This Beckham goodbye has different tone" (November 2009).
____________________________

Heel spurs - Is there any danger in one cortisone shot to each heel?

Gary
I am 53 and suffering from heel spurs. I tried off the shelf orthotics and am going to a custom in a few days. Trying to prevent surgery. My podiatrist says I should try one shot of cortisone only before going to surgery-do you agree? Is there any danger in one shot to each heel?
Thanks

Mike
______________________________
Gary replies:

Mike, let me answer your question by telling you about the very first time I witnessed the harm that these injections are doing to fit and healthy people.

He was a talented middle distance track athlete during the 1970's and early 80's, biting at the heels of athletes like John Walker, Dick Quax and Rod Dixon.

He developed a painful heel spur in one foot. Several courses of physiotherapy gave no relief. The sports physician he consulted gave him a single cortisone shot into the base of his heel. The pain relief was almost instantaneous. He was advised to rest up for a few weeks and then to very gradually resume running under the supervision of a physiotherapist. He carefully followed this advice.

He was out on an easy training run several months later when he felt and heard something snap in his foot. He was unable to run. To his horror, the arch of his foot had collapsed! His running career was over.

When I examined his foot a few years after this incident, I was shocked with what I found: The arch of the affected foot was non-existent. The plantar fascia had completely detached from the heel bone. In addition, the fatty heel pad under the thick skin of the heel had completely disappeared, leaving a hollow about the size of a 50 cent coin through which the heel bone was easily palpated.

That foot had lost its spring. The heel bone was now without its protective fat pad, causing jarring pain even when walking. The collapsed foot was making the foot rotate inwards, causing stress on the knee joint which was showing signs of painful arthritis. Running from now on was completely out of the question.

All of this career-ending damage was due to just a single quick-fix injection. I have since seen numerous cases of permanent damage and disability caused by cortisone injections.

Cortisone is a quick and convenient form of chemical excision. It is a surgical procedure. The trouble with this surgical procedure is the chemical is indiscriminate about which structures it kills off. It can leak into other tissues other than the piece of gristle being injected and it only takes an errant drop or two to do irreparable damage. It does not deal with the underlying causes.

Doctors are well aware of the hazards of injecting cortisone and, like the doctor in the example above, most responsibly follow the strict guidelines for their administration. But these guidelines make the flawed assumption that cortisone can be safely injected into structures like tendon sheaths and tendon attachments. The problem with this handy surgical procedure is that there can be months or even years of lag between its administration and the expression of harm, like the development of an arthritic ankle or a ruptured muscles or tendon. In most cases, the connection may never be made and certainly could not be proven.

In some cases, however, the connection is very obvious because the point of injection can be seen years later in addition to the consequent disability. The photo that accompanies this article shows the injection point into the sore ankle of a female athlete. You can see how the cortisone dissolved the ankle's structural tissue leaving a distinct hollow in the ankle which is now permanently and painfully weakened.

My advice is to go back to your podiatrist and patiently explore all of the possible underlying causes of the heel pain. What is really causing the heel spur? The answer will be multifactoral with issues like poor nutrition, weight gain, weak leg muscles, unsuitable footwear and doing too much exercise all at once, rather than less exercise more often. Medication such as statins and bisphosphonates are known contributors to muscle, tendon, bone and joint harm and far too many 50 year olds are being needlessly placed on these drugs.

Each must be thoroughly investigated and each put soundly to rest before resorting to surgical procedures, including cortisone injections. Such procedures will ultimately be doomed to failure if the underlying causations of your pain are not dealt with. This takes time and discipline.

With surgery there is no going back if it goes horribly wrong, so please give the conservative measures a good and proper go first.

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Cortisone Injections - pain relief at what cost? (Updated)

Note: This is an update of an earlier article.

Let me present the case of a very fit woman who, by anybody's terms, completely overdid the exercise for a few months towards the end of last year. She developed left ankle pain that would not resolve. She was referred to a sports medicine physician who injected the spot with hydrocortisone. Being a sports physician, he would have been well aware of the risks associated with these injections and would have exercised due care with the procedure.

The relief was immediate and she was able to resume normal activities several days later.

About 6 months later, she developed diffuse ankle joint pain when running. It refused to respond to treatment, including rest. The ankle would throb while sitting. Running out of options, she came to see me.

Photo One shows the left ankle appearing to be less meaty in appearance as compared to the right. 

Photo Two shows a hollow towards the front margins of the ankle bone 

Photo Three shows a marked hollow where there should normally be fat and ligaments 

Her case is quite typical of what I see months after cortisone injections and long after the patient has been declared "cured" of their musculoskeletal pain.

So, what is going on here?

What hydrocortisone does
Hydrocortisone is a means of doing a "chemical exision". In other words, it is a way of removing tissue without the need to cut. The chemical literally dissolves tissue. This is very effective at removing spots of persistent pain - it makes the problem literally disappear!

The problem
While it removes the pain, it invariably leaves the structure weakened. Furthermore, wherever the fluid leaks, tissue is killed off. In this case, healthy tissue - including shock absorbing fat and gristle and protective ligaments were damaged and even disappeared altogether!

It would also appear that some cortisone leaked into the joint itself, causing arthritic changes that now show as diffuse pain throughout the ankle joint, including the other side and general throbbing.

These complications are common. The first instance I can recall was of a running mate who was just on the heels of elite milers like Dixon, Quax and Walker. He developed plantar fasciitis of the foot and had a cortisone injection that fixed the problem. A few months later, he was out for a training run when he felt something snap in his foot. The plantar fascia had completely detached from the heel bone. His foot catastrophically collapsed. When I examined his foot, the arch was absent, he had knee pain due to altered foot mechanics and there was no fatty pad under the skin of his heel - it had been completely dissolved! That was the end of his running career.

Once the tissue is gone, it aint ever coming back.

I have seen plenty of cases of delayed complications. Possibly the most common is cortisone injections to relieve tennis elbow types of pain. This can result in complete avulsion of the wrist extensor muscle where it attaches at the elbow.

In these kinds of cases where there is a delayed complication, the treating doctor may forever remain blissfully unaware and will have chalked the case up as a treatment success.

Sometimes, the cure can be much worse than the ailment itself.