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Jonathan Cluett, M.D.

Healing Tendons With Injections

By July 6, 2013

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Injections are a common treatment for tendon problems.  Different types of injections including cortisone and PRP injections are commonly used to treat tendon conditions.  Cortisone is a powerful anti-inflammatory medication often used to treated acute inflammation (tendonitis) or chronic tendon problems (tendinosis).  PRP is a recent development that uses your own cells to stimulate healing in areas of chronic tendon damage.

A recent study from The Lancet, one of the leading medical journals, has tried to compile data from many other studies to determine the best use of injections for tendon problems. While the findings varied, there were a few take home points.  Of note, this type of study is called a meta-analysis, and attempts to combine the data from many studies to make the results more meaningful.  The researchers found:

For the treatment of tennis elbow, injections of cortisone helped in the short-term, but led to a worse long-term prognosis.

PRP was no more effective than placebo for treatment of Achilles tendinosis.

The effect of cortisone injection on the treatment of rotator cuff tendonitis is unclear, but it is probably not harmful.

These were several of the take-home points of the article.  I think cortisone is a useful treatment in cases of acute inflammation.  However, many tendon problems represent a chronic tendinosis, not acute inflammation, and therefore cortisone injections are likely prescribed too often.  Furthermore, short-term relief should be balanced with long-term goals--cortisone injections may not always be the best for long-term relief.  Lastly, PRP has yet to show any consistent effects of curing chronic tendon problems.

Sources: "Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials"

Comments
November 8, 2010 at 5:44 pm
(1) Joseph Putnoki says:

I came across warnings about cortisone injections. Examples of elite sportsmen and women became irrevocably disabled after a single, often the first ever injection. Unable to complete and tendons destroyed. I think the absolute assessment possible at present should inform the practitioner and the patient and topical complementary creams tried as well. Of course only quality and proven such medication to be applied, Beware the charlatans but recognize also alternative medicine has no monopoly on charlatans, allopathic medicine has it’s share and worse: many drugs are unnecessarily dangerous, ineffective yet allowed, not tested enough before released for the market and patients used as guinea pigs as the proble4ms surface down the track. Both doctors and patients need to be educated to available options that are outside the square. Many doctors delude themselves they do good while doing harm unaware they are captured by the drug industry. The flip side is many alternative practitioners delude themselves some of their treatments are helping based on their strong belief. Medicines are important so I am not into pharma-bashing. But the companies need be closely scrutinized as they became predatory, greedy, some outright corrupt and corrupting doctors. To my mind the best situation is informed consent from patients working cooperatively with their practitioners who are free-range doctors not captured by the industry and also in cooperation with valid complementary healers who can demonstrate effectiveness of their treatments. Testimonials are a double edged sword: some are true, others are easy fake.
The ability, willingness and integrity of the practitioner should not be too much to ask for.

Be well!

November 9, 2010 at 8:30 pm
(2) touchingsoulsintl says:

Cortisone is very effective anti-inflammatory medication used for the acute inflammation, which gives the relief immediately. In my personal experience a combination of cortisone injection along with physiotherapy works great for these inflammations.

November 21, 2010 at 9:12 pm
(3) Rob Tso says:

I have OA, my hands and knees are the most problematic. I have been injected with corizone ad it helps but the longterm side effects scare me silly. I went to a natural health fair and found a product by chance called Nateuca eucalyptus spray. I overheard someone telling the vendor how great their hands felt after spraying the stuff on themselves. I was skeptical but interested. The fellow said he helps people and is amazed at how well it works as he watches them walk away feeling so much better after using the spray. I’m no dr but I will say this after using the product I have quit using pain meds and anti inflammatory pills. I found that they were dulling the pain and my life. With NATEUCA spray that is history. I know it sounds crazy but I don’t want to tke medications the rest of my life and for months Ihave been free from joint pain. Just thougth I would share. nateuca.com

December 17, 2010 at 1:48 pm
(4) Carlos Meza Letelier says:

thanks for the inflo dr CLuett, i am student of medicine in Chile, and ocuppy your blog for a work of english (language). I have understood that cortisone injections bring positive effects in the short term but can bring adverse effects long pulazo. I agree with you that is put in a balance immediate results with the problems that could lead to therapy.
thanks for the info … lucky :D

December 20, 2010 at 1:26 am
(5) Achilles heel pain says:

Hi,
Thanks for your blog post on Achilles tendinosis and its no effect with PRP. I’ll add a backlink from my blog referring to you.
Best!
Lars

January 3, 2011 at 8:38 pm
(6) David says:

While cortisone injections works well in decreasing pain, the effect is mostly temporary. Combining it with physical therapy may be more effective for the patient rather than cortisone injections alone.

January 3, 2011 at 10:11 pm
(7) Chin says:

I really enjoyed your post, I just bookmarked this one and do you mind if I tweet your blog post out to my followers on twitter? I think they would also enjoy the blog post. I also wrote an article on my blog about tendonitis treatment ankle
please check it out.

Thanks.
Chin

June 9, 2011 at 9:22 am
(8) Charlotte Chiropractor says:

In studies it actually has been found that cortisone injections prolong the healing time. It is always important to check the biomechanics and body’s proper function is correct and is not putting undue stress on those tissues at question.

April 12, 2012 at 4:49 pm
(9) MA says:

Read the comment about NATEUCA spray and used it myself for knee problem ( medial menescus).I found it to be effective and soothing and it also worked well on my carpal tunnel in my hand. I much prefer natural products if they can do the job. This one does it for me.

October 10, 2012 at 9:06 pm
(10) Alejandra says:

I had 2 cortisone shots in my right and left wrist cuz of tendinitis and they didn’t work for me at all i end having surgery in both hands.. Am RN and i disagree with cortisone shots the only thing they do is blow you like a balloon it make you gain weight very badly. it will work just in very small injuries or that are not being injured for to long

November 5, 2012 at 1:11 pm
(11) chris says:

Does anyone know were i can purchase the product NATEUCA eucalyptus spray, my husband has carpal tunnel and is recieving no assistance from doctor or hospital, We live in Southern Ireland ( eire ).

August 19, 2013 at 5:18 pm
(12) pushups Workout says:

I must thank you for the efforts you’ve put in writing this blog. I am hoping to check out the same high-grade blog posts by you in the future as well. In fact, your creative writing abilities has inspired me to get my own, personal site now ;)

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