I recently had a cortisone shot in the tendon of my middle finger to burst some type of cyst that formed after an injury. It feels much better now and I am climbing after a three-week rest, but I am curious if the tendon will return to full strength?
ERIC PATRICK | Austin, TX
Cortisone is the cocaine of modern athletes, though much less fun (I wouldn't know, I didn't inhale). Many sporty people seem to feel they need a regular shot and advertise it like a badge of honor. Cortisone is probably the most over prescribed drug in modern medicine outside of all the others.
A metabolite of the catabolic steroid hormone cortisol, cortisone is involved in stress response. In the sporting domain, cortisone is predominantly used as a pain killer and anti-inflammatory (read: Band-Aid therapy). It is not so much the side effects that get my goat, but rather the complete lack of therapy that an injection entails. Cortisone is seldom a solution.
I think the majority of consultations follow this simple sequence:
Patient: I have blah-blah problem.
Doctor: There's nothing I can do about that. But we could give you a cortisone shot if you like.
What the doctor does not say is that the inflammation is not the cause of your problem, it's a symptom. CAN ANYONE HEAR ME?
For the most part, athletes are dealing with potential side effects from single doses rather than chronic use. Though side effects are typically minimal in the short term, cortisone does weaken tendons at the site of injection, and ruptures have been reported.
Though recurrence is disappointingly common, injecting cysts with cortisone can be helpful. In the instance that the cyst does not return, tendon strength should return within several months. Be very careful about excessively loading the tendon early on (at about three to four weeks). Not only will the cyst have weakened the tendon, the cortisone will be whipping up a catabolic hurricane: brief but furious.
Cortisone is a very common active ingredient in dermatitis medication. The irony that corticosteroids (of which cortisone is one) were voted Allergen of the Year by the American Contact Dermatitis Society is testament that not everybody agrees with its widespread use.
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