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Jonathan Cluett, M.D.

Does Cortisone Harm Joint Cartilage?

By November 9, 2012

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Cortisone injections are frequently used in the treatment of orthopedic problems. Some people are wary of cortisone injections because they have heard that this medication can lead to damage of normal cartilage, ligaments and tendons. Is this true? Does cortisone cause joint damage?

There is some truth to this statement, and cortisone should be used sparingly, especially in young, healthy joints.

  • Young, Healthy Patients
    When someone has a normal, healthy joint, I use cortisone sparingly. In these settings, I will almost always try treatments to minimize inflammation without injecting cortisone. If these efforts fail, cortisone, in minimal doses, may be a reasonable treatment to consider.

     



  • People with Damaged Joints
    I have much less concern about potential of joint damage in people who have severely damaged joints. For example, people with severe knee arthritis should not worry as much about possible cortisone damage to joints when the arthritis has already severely worn away the normal joint.

Some doctors use a specified number of cortisone injections they will offer in a given year. I prefer to use judgment. Cortisone also has other side-effects that should be considered when deciding if an injection is appropriate.

Comments
November 18, 2008 at 12:02 pm
(1) Sandy B says:

As one with severe osteoarthritis I have found cortisone injections – knee, toes, wrists – to be life-savers. I went from not being able to bend my knee to no pain. Synvisc injections are also working and I praise God for the medical advances.

June 1, 2011 at 3:29 pm
(2) KathyCoe says:

My own experience may be idiosyncratic, but I am at a loss for an explanation for the Grade IV chondrolysis in my shoulder, other than the 3 treatments of cortisone injections (9-11 injections each session, bilaterally) within a year, given by my PCP. Rather than do an MRI, both my PCP, and the Orthopedist I initially sought a referral to, decided ‘conservative’ treatment was sufficient. After beginning with severe pain and proceeding to even more severe pain I finally had surgery, only to find that I had ‘significant’ chondrolysis, in addition to the usual culprits. (Per the surgeon, he had only seen one similar shoulder in 30 yrs of practice.) I am petite, and I don’t know if that affected the depth of injection or degree of local concentration of the cortisone injections. I had no pre-op hx of a pain pump or thermal tx. I understand there is a small amt of anesthetic in cortisone injections, and I wonder just how much is required to cause the loss correlated with pain pump usage? Although the current assumption is that the associated anesthetic distributed locally via pain pumps is considerable, tissue data implicates much smaller doses are chondrolytic.

At present my new Orthopedist is recommending cortisone injections for my hip, although I am quite sure there is underlying injury to the gluteus, not revealed on MRI. I do not have a hx of arthritis, was very physically active until the shoulder issue–cert’d as a personal trainer and a 5-mi/day runner–and am 65. I am willing to trust this MD’s opinion that my hip is at less risk, due to anatomy, than the shoulder, but I suspect that the data evolves, cortisone will be relegated to only the more damaged joints, as you are trending towards. (I’m concerned that the data will be severely curtailed by another trend–diminished accessibility of aging patients to rotator cuff tx, with the excuse that cadaver evidence shows substantial incidence of asymptommatic damage comparable to patients requesting tx. )

August 30, 2011 at 9:03 pm
(3) KathyCoe says:

I wanted to add to my existing information that there was damage to my rotator cuff which precipitated the pain, as I suspected–the usual tendon and cuff tears, and the usual SLAP I, repairs and decompression were done, as well as a microfracture for the cartilage damage, unusual in a shoulder. Unfortunately, the cartilage was ‘dissolving’ and falling off the joint in large chunks, which, per the surgeon, could not be due to mechanical injury.

My own conclusion was that the anatomical damage provided the source for inflammation, the reason the first round of cortisone reduced the pain. The second round produced no relief, but my PCP proceeded to a third round, insisting he could not get approval for the MRI I requested without it. He also continued to diagnose my pain as fibromyalgia, despite my insistance that it did not meet diagnostic criteria for that and that I knew I had injured my shoulders–the only source of pain for several years. He then consistently over- and misprescribed subsequent medications.

I don’t think that the unusual cartilage loss I sustained is typical of treatment by responsible practitioners and it’s rarity in the literature supports that.

I have just changed my PCP and provider group–obviously something that would have been better done before the damage. I remained with them post op as they are within walking distance and I had trouble driving due to the shoulder problem. I would recommend that anyone who has the slightest suspicion that their care is suboptimal research credible sites, such as this, to make sure their treatment meets established guidelines.

Time limits in today’s restrictive medical climate make it difficult to ask all the recommended questions of your own physician. I have a fairly good background and, despite that, now have a permanently painful condition and functional loss as a result of wanting to trust this PCP’s judgment. Doing my homework post facto was not a smart move. Be smart.

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