Cortisone

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Experience From - Rich Schick , Terri Handy PT ATC ,


Rich Schick

Steroids should not be injected directly into tendons or cartilege, this can be very harmful. Injecting near these structures can be helpful though there is some evidence that tendons can be more prone to rupture for several weeks after injections given near them. Below are a couple abstracts on the subject.

Title: Local corticosteroid injection in sport: review of literature and guidelines for treatment.
Author: Fredberg U
Address: AGF Professional Soccer A/S, Aarhus, Denmark.
Source: Scand J Med Sci Sports, 7(3):131-9 1997 Jun

Abstract:
The risks and benefits of local injection therapy of overuse sports injuries with corticosteroids are reviewed here. Injection of corticosteroid inside the tendon has a deleterious effect on the tendon tissue and should be unanimously condemned. No reliable proof exists of the deleterious effects of peritendinous injections. Too many conclusions in the literature are based on poor scientific evidence and it is just the reiteration of a dogma if all steroid injections are abandoned. The corticosteroids represent an adjuvant treatment in the overall management of sports injuries: basic treatment is 'active' rest and graduated rehabilitation within the limits of pain. With proper indications there are only few and trivial complications that may occur with corticosteroid injections. Guidelines for proper local injection therapy with corticosteroids are given.

Title: Joint and soft-tissue injection. A useful adjuvant to systemic and local treatment.
Author: Genovese MC
Address: Division of Immunology and Rheumatology, Stanford University Medical Center, Stanford, CA 94305, USA.
Source: Postgrad Med, 103(2):125-34 1998 Feb

Abstract:
Joint and soft-tissue injection can augment systemic and local conservative treatment and have long-lasting benefits. Inflammatory and crystalline arthritis, synovitis, tendinitis, bursitis, and many other conditions respond well to injection. Corticosteroid preparations should be chosen on the basis of solubility and potency desired and the size of structure to be injected. Injections should not be made directly into a ligament or tendon and should be limited to every third or fourth month. With attention to the usual cautions required with corticosteroid use and avoidance of contraindications (e.g., bacteremia, fracture), injection is usually safe and effective, particularly as a bridging technique to long-term therapy.

Title: Local corticosteroid injection in sport: review of literature and guidelines for treatment.
Author: Fredberg U
Address: AGF Professional Soccer A/S, Aarhus, Denmark.
Source: Scand J Med Sci Sports, 7(3):131-9 1997 Jun

Abstract:
The risks and benefits of local injection therapy of overuse sports injuries with corticosteroids are reviewed here. Injection of corticosteroid inside the tendon has a deleterious effect on the tendon tissue and should be unanimously condemned. No reliable proof exists of the deleterious effects of peritendinous injections. Too many conclusions in the literature are based on poor scientific evidence and it is just the reiteration of a dogma if all steroid injections are abandoned. The corticosteroids represent an adjuvant treatment in the overall management of sports injuries: basic treatment is 'active' rest and graduated rehabilitation within the limits of pain. With proper indications there are only few and trivial complications that may occur with corticosteroid injections. Guidelines for proper local injection therapy with corticosteroids are given.


Terri Handy PT ATC

Derick Page wrote:

"about iontophoresis with dex. instead of a steroid injection?"
Just my opinion with iontophoresis in general. It can't hurt if used as a part of physical therapy treatment --- not as a sole treatment. Over the past 10 years only a small percentage of clients that I have used it on got any major relief --- most of them were tennis elbow and true shoulder bursitis. Achilles tendons, plantar fascia and deeper structures --- it didn't seem to make any difference at all. As a PT I use modalities only as an adjunct. If something is hurting -- there is a reason and to just try to make the pain go away usually does more harm than good. Figure out the cause and try to correct it --- stretch, strengthen, revise training programs...etc.