Cortisone injection for back pain
When injecting into the back, the doctor aims to treat the muscles, veins or even joints. The cortisone injection is always mixed with a local anaesthetic, which is intended to break through the painful cramping and relieve the musculature. But experts are divided on the effectiveness of this form of therapy.
For example, there is no scientifically proven added value of an application of cortisone or anaesthetics in the muscle itself. Moreover, the danger of triggering an allergic reaction by application into a vein is given and has already led to isolated cases of shock and death. Systemic therapy with painkillers (NSAIDs) in combination with heat and gentle movement is therefore recommended.
Cortisone injection in the knee
A cortisone injection is also used on the knee when all other forms of therapy have failed. At intervals of 4 weeks, a dose of cortisone painkiller mixture is injected into the knee by syringe and local anaesthetic. An immediate improvement of the pain has been scientifically proven, but it is only short-lived: after four weeks at the latest, the pain is back and a new visit to the doctor is necessary.
In return, the injections are relatively cheap at 5-10€ per injection and are also covered by the health insurance. However, the injections do not offer a permanent solution, and you can also buy freedom from symptoms with a number of side effects. The risk-benefit ratio of cortisone injections is often judged by doctors to be too poor.
Cortisone syringe on the wrist
Even smaller joints such as the wrist can be treated with a cortisone injection. The injection is injected directly into the joint and usually consists of a cortisone-anaesthetic mixture. On the wrist it is used particularly in the course of carpal tunnel syndrome, in which the muscles and tendons swell and compress at wrist level.
In addition, a nerve running there, the median nerve, is compressed. Since the hand flexors are limited towards the surface by a taut tendon, the retinaculum flexorum, the compression results in a loss of function – the hand can no longer be bent. Women are particularly affected by this shortly after pregnancy.
They can be helped with a cortisone injection until the hormone balance has returned to normal. However, as with all other joints, the injection only lasts for a few weeks and must then be repeated if necessary. The main risk here is also an infection after insufficient disinfection of the injection site.
Cortisone injection for tennis elbow
Epicondylitis, colloquially known as tennis elbow, is an overloading of the tendons and muscles of the arm. It does not necessarily occur after playing tennis and can have a number of other causes associated with severe mechanical stress. As a rule, however, the pain radiates from the elbow and in advanced stages spreads to the wrist.
The outer side is usually affected more than the inner side. The procedure for tennis elbow does not differ from the therapy of other joints: an individually tailored mixture of cortisone and a local anaesthetic is injected into the elbow joint. The duration of the effect is 1-2 months, the short-term relief of symptoms occurs days after the injection.
In a case-control study with patients who were injected with a cortisone injection on the one hand and a placebo on the other hand, it was investigated which of the two groups showed fewer complaints in the long term. Interestingly, the cortisone injection group reported a lower average freedom from symptoms after 12 months of therapy than the placebo group, which received no active substance at all. Experts attribute this to the fact that the rapid pain relief in the cortisone syringe group led the patients to exercise the arm again more quickly, which worsened the symptoms in the long term.
Pain is a means by which the body signals to the brain that a certain movement or strain is not healthy. Even if they are extremely unpleasant, they still have a purpose. Accordingly, a complete elimination of pain does not necessarily always make sense, as the above study shows.
In practice, cortisone injections are now only used for illnesses with a foreseeable end of treatment – for example, after pregnancy. Osteoarthritis is a wear and tear of the joint caused by excessive or prolonged stress. It typically occurs with age or in obese patients.
The increased cartilage abrasion causes pain in the long run, as the bones in the joint that meet are no longer cushioned. Along with the pain comes the inflammatory reaction and swelling, which further aggravates the symptoms: the body produces an excessive amount of synovial fluid, so that the pressure inside the joint increases and even more impulses are sent out to the pain fibers. For therapy, therefore, a small amount of the synovial fluid is first punctured from the joint and the cortisone injection is injected through the same puncture site.
Since the cortisone is not absorbed and metabolised orally, the extent of the side effects is less severe. However, in addition to the usual side effects such as deterioration in blood sugar and fat levels and increased susceptibility to infection, muscle atrophy and joint cartilage damage also occur. This drastically worsens the symptoms in the long run, as a strong muscle tends to relieve the joint.
A misinjection into the surrounding fatty tissue can cause the fatty tissue to die off, which can also be visible externally. This can occur especially in the case of hip arthrosis, as access to the joint cavity is relatively difficult to find in this case. For this reason, therapy with cortisone injections is not a permanent solution for osteoarthritis, but only a short-term alternative. Instead, a combination therapy of physiotherapy, ointments and, in extreme cases, surgery should be considered. In the case of hip arthrosis, either the joint is shifted in its axis (so-called repositioning osteotomy) or the entire joint is replaced (total endoprosthesis/TEP, hip prosthesis).