# Cortisone: friend, or foe?



## mudflap (Feb 23, 2004)

I've recently learned a few things about cortisone the hard way. 
First, it doesn't work for everybody, but don't ask me why. It didn't help my shoulder after breaking off the head of my humorous and tearing all the soft tissue in the area of the joint, so after the first shot, I stopped them.
It did help with pain in my knee after tearing my meniscus as it gradually got to be more painful over the last two years. But while it helped alleviate the pain, it very insidiously was destroying the remaining cartilage of the meniscus over the first six months of this year when I received three cortisone shots at two-month intervals. Two months after the last shot, I was told I was a candidate for a Syn-visc (artificial joint lube) injection. Not long after that injection the pain came on strong. Did the cortisone shots hide the increasing cartilage deterioration and pain? I think it did, and then when the last cortisone shot wore off, I was faced with knee-joint pain that was truly a humbling experience. Not only did the S-v injection not help, but now-days, they won't perform knee surgery for a minimum of three months after a last injection of any kind: due to increased potential for infection in the surgery site. 
So, now I had to wait three more months before my recent total knee replacement surgery. Over those three months, things really went to hell. Walking became nearly impossible, and when I did walk, it was stiff legged, so that leg was always behind trying to keep up with my good leg. Sleeping at night was the real dilemma, as I couldn't straighten my leg without the pain going from zero to sixty just like that, and that would happen on-and-off during the night.
Bottom line: cortisone is both friend and foe. If you receive three or more shots in a row, plan on some kind of reconstructive surgery to that area within a year - my opinion only. 
Not my opinion, doctors' policy: no surgery for minimum of three months after any injection into the joint receiving surgery. For me this was the killer. I was ready for surgery when I got the Syn-visc injection, and then had to wait those three months in pain and major discomfort and immobility while the days literally trudged by.
I've since read Syn-visc is proven ineffective for bone-on-bone, so I screwed up there.
Hope you don't need any of these injections, but if you do, maybe this will help you make an informed decision.


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## Gym123 (Dec 4, 2021)

DO NOT use Cortisone if Kidney problems are likely or active and don't use it too much. I had an uncle who was one of the early patients to get it for his Rheumatoid Arthritis and it f&cked him up. I met him in late-'66 when I was a kid and he was a real mess. Completely bed-ridden for around 20 years by that time, his lower legs needed to be wrapped in Ace Bandages because his failing kidneys & heart couldn't remove the fluids, so they would split open if he sat upright for too long. 

Couldn't wipe the smile off of his face, though.


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## gdb85 (Mar 4, 2017)

Yep, it starts a degenerative process and just gets worse...


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## kpdemello (May 3, 2010)

Seems to me the issue with these injections is they mask the pain caused by the damage and allow you to be more active instead of resting. If the problem is inflammation due to relatively minor damage, I think the injections are helpful to get you back to full function. If you have significant structural damage, it's not going to help repair it, but it will make you feel good, allowing you to overstress an already damaged joint and do more damage.

I think the takeaway for me is that trying to avoid surgery is not always the best path. Sometimes the only fix is surgical, and putting it off just delays the inevitable and may make things worse.


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## frana (Jan 5, 2008)

The general rule is not more than 3 cortisone injections in a year. Every 2 months seems too close together.


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## Nat (Dec 30, 2003)

frana said:


> The general rule is not more than 3 cortisone injections in a year.


Times how many years?


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## Jayem (Jul 16, 2005)

Wow…lots of bad info here. 

More than two in a joint/area will cause the tissue to deteriorate/dissolve. Most Docs…that know you are getting a shot, won’t do more than this…but as far as I know, its location specific. Cortisone shots can do an amazing job at reducing inflammation and pain, but are often more of a temporary fix for any problem where they are used. I’ve gotten them and it was like the problem magically went away in a day. Of course the Doc said it wouldn’t cure the problem alone, but it has its uses.

Ive heard of people getting dozens of injections…even in the same place. It mainly seems to be when the patient hasn’t communicated their medical history.


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## Gym123 (Dec 4, 2021)

kpdemello said:


> Seems to me the issue with these injections is they mask the pain caused by the damage and allow you to be more active instead of resting. If the problem is inflammation due to relatively minor damage, I think the injections are helpful to get you back to full function. If you have significant structural damage, it's not going to help repair it, but it will make you feel good, allowing you to overstress an already damaged joint and do more damage.
> 
> I think the takeaway for me is that trying to avoid surgery is not always the best path. Sometimes the only fix is surgical, and putting it off just delays the inevitable and may make things worse.


Sometimes, surgery isn't likely because SOME Drs don't do their GD job and ignore the choice to actually diagnose the full extent of the injury, like my knee. I went back and the idiot ordered an MRI- after seeing it, he said "That's a lot worse than I thought". I'm not even sure he was listening when I told him how I did it although he remembers most of the visit as well as I do....and this guy was recommended by people I know, one being the son of another Orthopedic surgeon (who works at the same place). I told him it was bad, he didn't believe much of what I said, actually seems to have ignored some of it and wanted to argue when I would add info. When I went back for the consultation for the MRI, he said that there's no guarantee the surgery to repair my Quad tendon will be successful and if it's not, I wouldn't be a good candidate for a replacement. Now, he wants to pawn me off on someone else for further consultation which, I assume, is to share the blame for his crappy diagnosis, that he actually admitted to. If only they were required to record all Dr/patient conversations and if only I had thought he might say this stuff.....

Thanks, douchbag- your crappy diagnosis has wasted the last year+ of my life because my mobility is severely reduced. I can't wait to see how bad this becomes and deal with the fact that I can't do most of what I want, like or need to.


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## Gym123 (Dec 4, 2021)

Jayem said:


> Wow…lots of bad info here.
> 
> More than two in a joint/area will cause the tissue to deteriorate/dissolve. Most Docs…that know you are getting a shot, won’t do more than this…but as far as I know, its location specific. Cortisone shots can do an amazing job at reducing inflammation and pain, but are often more of a temporary fix for any problem where they are used. I’ve gotten them and it was like the problem magically went away in a day. Of course the Doc said it wouldn’t cure the problem alone, but it has its uses.
> 
> Ive heard of people getting dozens of injections…even in the same place. It mainly seems to be when the patient hasn’t communicated their medical history.


I would think anyone injecting this kind of drug would want to look at the patient's prior treatment history.


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## Nat (Dec 30, 2003)

Gym123 said:


> Now, he wants to pawn me off on someone else for further consultation which, I assume, is to share the blame for his crappy diagnosis, which he actually admitted. If only they were required to record all Dr/patient conversations.....


When a doctor tells me that I read between the lines that the person in front of me isn't comfortable handling whatever problem is on front of them. It would be way worse for them to take you to the operating room if they're not confident in what procedure is about to happen.


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## Nat (Dec 30, 2003)

Gym123 said:


> I would think anyone injecting this kind of drug would want to look at the patient's prior treatment history.


I thought what he was saying is that some patients either accidentally or purposely omit the fact that they've had previous steroid injections. Jayem?


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## dysfunction (Aug 15, 2009)

Gym123 said:


> I would think anyone injecting this kind of drug would want to look at the patient's prior treatment history.


Pretty sure there isn't a single source for this info in the US. Most of the time it seems medical professionals have to rely on what the patient reports.


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## kpdemello (May 3, 2010)

I've learned you definitely have to insist on imaging if your doc is hesitant, and not be afraid to go for 2nd opinions. I would also say that going to a big city where docs ultra specialize is far better than going to your local doc who might do shoulders, knees, wrists and whatever else because he doesn't have enough business to just be a knee guy.


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## frana (Jan 5, 2008)

Nat said:


> Times how many years?


Sometimes its the last alternative before surgery. Dr and patient of course need to talk about goals etc. Everyone is different, goals, activity levels etc. After 3 shots , its time to look at alternatives.


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## Nat (Dec 30, 2003)

frana said:


> Sometimes its the last alternative before surgery. Dr and patient of course need to talk about goals etc. Everyone is different, goals, activity levels etc. After 3 shots , its time to look at alternatives.


So max is 3 shots per year x 1 year?


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## frana (Jan 5, 2008)

Nat said:


> So max is 3 shots per year x 1 year?


Response #5.


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## Nat (Dec 30, 2003)

frana said:


> Response #5.


Would you happen to know of any scientific literature stating so? When I’ve looked I’ve only found anecdote (mostly websites and word of mouth) saying you can get 3-4 shots per year maximum but I haven’t come across any scholarly articles stating the maximum number of years. I am under the impression that the 3/yr. practice standard has been passed down by word of mouth (medical dogma) rather than a quantity based on evidence. I’d like to be proven otherwise just to know that I’m not guilty of parroting.

I'll put this out there to everyone -- please show me one scholarly article (not blog post, not website, etc.) that says 3 shots max so I know I'm not just repeating what I've been told.


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## #mtnbykr (Jun 6, 2014)

how much cortisone is too much - Google Search


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## Gym123 (Dec 4, 2021)

dysfunction said:


> Pretty sure there isn't a single source for this info in the US. Most of the time it seems medical professionals have to rely on what the patient reports.


WRT patient- provided info- I hit the back of my head on a rafter in an old house and when I went to the clinic for treatment, the Dr asked if I had lost consciousness. I replied with "You're asking someone with a fresh head wound?" and he said, "OK, fair enough". 

I needed to go to an ER and they had all of the records from the past and I hadn't been admitted there before. Later, I went to an orthopedic surgeon and they had everything, too. It's all in digital form now, but they also make everyone sign HIPPA forms and part of that is portability of the patient's records.


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## dysfunction (Aug 15, 2009)

Gym123 said:


> I needed to go to an ER and they had all of the records from the past and I hadn't been admitted there before. Later, I went to an orthopedic surgeon and they had everything, too. It's all in digital form now, but they also make everyone sign HIPPA forms and part of that is portability of the patient's records.


Yet, I spent the last year answering the same questions over, and over, and over, and over again with way too many admissions and doctors appointments with parents. You've clearly got a better local system.


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## Nat (Dec 30, 2003)

Gym123 said:


> I needed to go to an ER and they had all of the records from the past and I hadn't been admitted there before. Later, I went to an orthopedic surgeon and they had everything, too. It's all in digital form now, but they also make everyone sign HIPPA forms and part of that is portability of the patient's records.


If all of the clinics you go to are within the same network and use the same EHR then they all have access to your records but not every clinic uses the same EHR.

Also, medical providers are only required to keep your record for 7 years. If you got a cortisone shot (or any other treatment) more than 7 years ago then that record could be lost. You have to provide the info to your new clinic; They won't just automatically know.


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## Gym123 (Dec 4, 2021)

Nat said:


> When a doctor tells me that I read between the lines that the person in front of me isn't comfortable handling whatever problem is on front of them. It would be way worse for them to take you to the operating room if they're not confident in what procedure is about to happen.


The surgeon he recommended is more of a sports injury type which, if I had known what I know now, is who I should have gone to in the first place but this guy was highly recommended. I effed up- I trusted them. 

I just remind myself that they're only practicing medicine.


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## Nat (Dec 30, 2003)

Gym123 said:


> The surgeon he recommended is more of a sports injury type which, if I had known what I know now, is who I should have gone to in the first place but this guy was highly recommended. I effed up- I trusted them.
> 
> I just remind myself that they're only practicing medicine.


Man, that sucks


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## Gym123 (Dec 4, 2021)

Nat said:


> Man, that sucks


In light of the way I landed, I guess I can consider myself free of the fear of Osteoporosis and I didn't damage any of the ligaments or other tendons. Now that I know more about how the human knee is constructed, I'm amazed by its ability to handle everything we throw at them- one tendon handles all of the tension above the patella and one tendon handles all of the tension below it. I used to jump off of the ski platforms on boats when I worked for two boat dealers as a service tech- the boats weren't huge, but the platforms were sometimes 5'-6' above the ground when the boats were on trailers and this was after I turned 40. 

I may have posted him responding with "I don't know why you couldn't reach 100%" to me saying "At this point, I might be OK with reaching 80%"- he clearly made an assumption that was incredibly far from accurate. As it turns out, my Quad tension is stretched and has a 3.1cm tear at the outside, so the muscles can't do their job as well as they should because they won't contract enough and that makes it impossible for me to fully extend my leg. That means I have little ability to resist force that pushes my foot backward from about 75% to completely straight, so it tends to buckle when I step down onto a lower surface, hit a high spot with my foot or just out of the blue. This sucks and if this nimrod thinks I'm going to just sit here and do nothing, he's dead wrong. The morning I messed up my knee, I had jumped down from my folding Aluminum platform but when I tried to step onto it form my ladder and it wasn't where it was supposed to be, If I had all a whole second to think about how I was going to land, that would be a lot. I needed to consider whether I would land of both feet or one, how I might need to roll, how I could land without ending up flat on my back on the concrete whether I was going to try to step forward or to the side, etc.

Stairs suck, going up or down. I used to do AV. home theater, network sales and installation, all of which usually involved a lot of stairs, carrying a good amount of weight. Well, that's basically done. I checked the pedometer in my iPhone after a grueling day and it showed why I was tired- 41 flights of stairs in one day and I had to carry something almost every trip up and down. Same house, I had to horse a 50" plasma TV from the first floor to the 3rd, so I could install it. That was fun, but it would be very hard, now. I hate that I now have to think about how I walk, to prevent taking a digger on flat ground.


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## frana (Jan 5, 2008)

Nat said:


> Would you happen to know of any scientific literature stating so? When I’ve looked I’ve only found anecdote (mostly websites and word of mouth) saying you can get 3-4 shots per year maximum but I haven’t come across any scholarly articles stating the maximum number of years. I am under the impression that the 3/yr. practice standard has been passed down by word of mouth (medical dogma) rather than a quantity based on evidence. I’d like to be proven otherwise just to know that I’m not guilty of parroting.
> 
> I'll put this out there to everyone -- please show me one scholarly article (not blog post, not website, etc.) that says 3 shots max so I know I'm not just repeating what I've been told.


You can do a search if you like. My information is from several orthopedic doctors in our area , common practice here. I'm an occupational therapist BTW.


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## Nat (Dec 30, 2003)

frana said:


> You can do a search if you like. My information is from several orthopedic doctors in our area , common practice here. I'm an occupational therapist BTW.


Thanks for your replies frana. I had a hunch that you had a medical background, which is why I was asking you. It wasn’t to pick on you.

The above replies demonstrate what I’m getting at though. I too have heard “no more than three shots per year “ but then when I’ve asked “times how many years?” I get assorted responses ranging from “one year,” “a few years,” “not too long,” “per lifetime,” to “it's time to talk about surgery.”

I’ve searched for literature and what I find is vague. The oft-quoted “three per year max” is common practice but I haven’t been able to find any study that it’s based upon.


Here are some snippets I've found while searching:

_"In general, you shouldn't get cortisone injections more often than every six weeks and usually not more than three or four times a year."_ -- Cortisone shots - Mayo Clinic

And

_"There’s somewhat of an unwritten rule in our profession that we shouldn’t give more than three in a calendar year. I know practitioners who follow that strictly, and I know practitioners who don’t believe in that at all. I tend to follow that. Most patients of mine will receive one injection. There’s a few who may receive a second. Very, very infrequently do I give a third. And if I do give a third injection, it’s not for many months past the first injection." 

Campbell recommends at least six weeks between injections and no more than three to four injections per year." -- _





Debating corticosteroid injections for heel pain | Lower Extremity Review Magazine


Even advocates of corticosteroid injection for patients with plantar fasciitis believe the treatment is judt one piece of a complicated therapeutic puzzle.




lermagazine.com





And

"_There is no medical limit on the number of injections a person can receive. However, there are concerns about repeated cortisone injections in specific areas of the body. Also, individual response to a cortisone shot varies. Some patients do not experience pain relief with cortisone treatments. If the first injection doesn’t provide pain relief, your doctor may try a second injection four to six weeks later. If there’s no improvement after the second injection, a third injection is not recommended._" -- How Long Does a Cortisone Shot Last?


It seems like people (doctors included) are just repeating what they've heard from someone else. I think treatment based on "That's how everyone does it" or "That's what I was taught" happens more often than we'd like to acknowledge.


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## Unbrockenchain (Aug 21, 2015)

I had a shot for shoulder I fell on skiing and not only fixed it but also fixed arthritis in neck (neither have come back). But didn’t help when I feel on other shoulder


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## frana (Jan 5, 2008)

Nat said:


> Thanks for your replies frana. I had a hunch that you had a medical background, which is why I was asking you. It wasn’t to pick on you.
> 
> The above replies demonstrate what I’m getting at though. I too have heard “no more than three shots per year “ but then when I’ve asked “times how many years?” I get assorted responses ranging from “one year,” “a few years,” “not too long,” “per lifetime,” to “it's time to talk about surgery.”
> 
> ...


There's a reason they call it "practing" medicine. Drs often discuss amongst themselves on how to treat a person, it's not 1 size fits all. In a way it is what they've heard from others and also evidenced based decisions. It's a mixture of science and
"art" if you will. Science is always evolving with new evidence and expanding knowlege of what is seen in the clinic. (One of the reasons people seemed to reject science during the pandemic, not understanding that answers aren't static, they can change.)


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## edubfromktown (Sep 7, 2010)

It was my "friend" years ago. Only time for me was a course of 3 epidural shots in hopes of chasing away chronic lower back inflammation and pain (that had been going on for a decade).

My orthopedist (4th one... 1st three all recommended surgery) said that I might not notice any difference after 1, 2 or all 3 but to make sure to complete the treatment regardless. He was partially correct. Felt no difference after two. After the 3rd, the pain went away and has for the most part stayed that way for ~8 years.


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## Gym123 (Dec 4, 2021)

frana said:


> There's a reason they call it "practing" medicine. Drs often discuss amongst themselves on how to treat a person, it's not 1 size fits all. In a way it is what they've heard from others and also evidenced based decisions. It's a mixture of science and
> "art" if you will. Science is always evolving with new evidence and expanding knowlege of what is seen in the clinic. (One of the reasons people seemed to reject science during the pandemic, not understanding that answers aren't static, they can change.)


I would be more inclined to trust the ortho's opinion/diagnosis and consultation with another surgeon IF he had ordered the damned MRI at the beginning. Now, after more than a year, it's absolutely impossible to know with certainty the condition of the knee at that time, so if the tear had only been 1cm, it would have been easier to repair. This guy does knee replacements and at least one of my customers was one of his patients (I saw her in the waiting room when I went the first time) but the two problems I have with this are: he didn't order an MRI and he made an assumption about what defines 'reaching 100%' means WRT my physical ability. Then, because of his incorrect diagnosis, the physical therapist was assuming that I had balance issues when the whole problem was strength and lack of tension in the tendon. She had me doing exercises that I should have avoided and thought I was just arguing when I told her I couldn't do certain things (like one-legged squats on that knee), but that place doesn't do any objective testing. I asked about that kind of testing- she asked why they should and asked how they might do it. I told her that without it, there's no way to know what my (or anyone elses') knee is capable of and if they wanted to, they could put a typical bathroom scale on the Total Gym, then check the weight when the knee fails to raise the patient. That idea had never occurred to them and AFAIK, they still don't do that. I can't imagine why they don't- it seems like it should be one of the first tests they do and I don't know how they can develop a treatment program without knowing this.


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## prj71 (Dec 29, 2014)

I have some cartilage missing in my right knee and instead of cortisone my doctor gave me supartz.









Supartz (Sodium Hyaluronate) for the Treatment of Knee Osteoarthritis: A Review of Efficacy and Safety


As concerns about the safety of systemic oral pharmacologic treatments for knee osteoarthritis (OA) mount, clinicians have increased the use of intra-articular hyaluronic acid (IA-HA) in managing mild-to-moderate knee OA. Supartz (sodium hyaluronate; ...




www.ncbi.nlm.nih.gov













How Supartz Injections Are Used to Relieve Knee Osteoarthritis


Learn about Supartz, a therapeutic injection used in viscosupplementation, which is approved for the treatment of knee osteoarthritis.




www.verywellhealth.com


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## mudflap (Feb 23, 2004)

I think I would have been a candidate for Supartz if I had been better informed.


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## LanceWeaklegs (Dec 24, 2019)

Cortisone doesn’t mask pain, it’s not a pain killer. It’s an anti inflammatory. The reason the pain goes away immediately after a shot is that there’s a little lidocaine in the tip of the syringe, so that when the cortisone injection needle hits all that inflamed tissue it won’t be as painful. The use of cortisone totally depends on where the problem is. Ie, they no longer give cortisone shots in elbow tendons, because they found the problem will usually return. I’ve had several shots over the years in my shoulders and back and they have always worked long term. Had one in the plantar fascia, ended up rupturing the tendon later. So get an experienced doctor that you trust, and trust him. I don’t make medical decisions based on forum posts.


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## frana (Jan 5, 2008)

LanceWeaklegs said:


> they no longer give cortisone shots in elbow tendons, because they found the problem will usually return.


It depends where you are. This is not completely accurate. Just saying what I see in my area of the world.


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## Jayem (Jul 16, 2005)

LanceWeaklegs said:


> Cortisone doesn’t mask pain, it’s not a pain killer. It’s an anti inflammatory. The reason the pain goes away immediately after a shot is that there’s a little lidocaine in the tip of the syringe, so that when the cortisone injection needle hits all that inflamed tissue it won’t be as painful. The use of cortisone totally depends on where the problem is. Ie, they no longer give cortisone shots in elbow tendons, because they found the problem will usually return. I’ve had several shots over the years in my shoulders and back and they have always worked long term. Had one in the plantar fascia, ended up rupturing the tendon later. So get an experienced doctor that you trust, and trust him. I don’t make medical decisions based on forum posts.


Ive never had the pain go away immediately, but I’ve heard the same spiel from the Drs about the anti-inflammatory part. They must have hit a nerve or something with my first shot in my ankle, a few hrs later it felt like id been shot in the foot…but over the next day or so the original issue got way better and it felt like a brand new foot…for around 6mo.


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## LanceWeaklegs (Dec 24, 2019)

frana said:


> It depends where you are. This is not completely accurate. Just saying what I see in my area of the world.


Ok, then, the American Academy of Orthopedic Surgeons now discourages cortisone shots for elbow tendinitis. That might not apply to foreign countries. My mistake.


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## levity (Oct 31, 2011)

Radiological Society of North America, Annual Mtg, Nov. 29, 2022.
Press release - "Steroid Injections Worsen Knee Arthritis"



https://press.rsna.org/timssnet/media/pressreleases/14_pr_target.cfm?id=2386


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## mudflap (Feb 23, 2004)

Great link. That study came out too late for my situation which occurred over the first 8 months of 2022. Wish I had been aware of it at the time, but here 7 weeks after total knee replacement, I can only act on spreading the word to all my aging friends.


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