Cortisone injection

introduction

As the bones get heavier and heavier over the years and the joints increasingly refuse to work, many of those affected get a "cortisone injection" given by the orthopedist of their choice. But even in young adults and adolescents, this therapy is usually used after sports injuries, which is supposed to bring pain relief and increased mobility.

But what exactly is cortisone (also spelled cortisone) and what is it when we talk about a cortisone injection? First of all, cortisone is a steroid hormone that is produced in the cortex of the adrenal gland. Steroid hormones are a group of hormones that have a certain similarity in structure due to their chemical structural formula - hence their name.

Cortisone was discovered in 1935 in the human adrenal cortex. The adrenal glands sit on top of the kidneys and produce other important cortisone in their cortex Adrenal hormones how adrenaline or estrogen.

But what exactly does cortisone do? First of all, cortisone has no effect on the body at all and has to be converted into its biologically active form, cortisol, in the liver. Cortisol is an absolutely vital hormone that intervenes in many processes in the body, for example fat metabolism, the sugar balance, but also protein turnover. Much more important for its use as a cortisone injection is that anti-inflammatory and immunosuppressive Effect. Inflammation is always associated with swelling, overheating, redness, pain and a loss of function. In other words, everything that you don't necessarily want to have in a joint.

A cortisone injection can be used at local Application in the joint Inhibiting inflammation and freedom from symptoms - but it does not address the cause of the problem. In addition, you buy the anti-inflammatory effect dearly with the immunosuppressive one - that is immune system braking effect. Although the application doses are always chosen in such a way that the side effects are kept as low as possible, fever or infections are often not uncommon in long-term therapies. The side effects are dealt with separately due to their relevance.

Read more on this topic at: Cortisone effect

Cortisone injection for a herniated disc

At the disc prolapse or - prolapse, pushes the Intervertebral disc into the spinal canal, which Spinal cord includes, before. The cause can be heavy lifting or sudden, wrong movement. The intervertebral disc is pushed onto the Nerve fibers of the spinal cord and presses on it.

A steady irritation of the Nerve root In addition to pain, it can also lead to inflammation, which is why you should treat it with a Cortisone injection tried to treat.
One stabs under local anesthesia (Local anesthesia) with a long syringe near the root (so-called minimally invasive spinal column therapy) and there delivers a bolus, i.e. a burst of cortisone. In the ideal case, a deposit with a sufficient amount of cortisone is then formed near the root, which causes the nerve root to swell and the Dampens pain response.
The bolus usually lasts several months, then further therapy is necessary. The basic problem, prolapse, has not yet been treated. Although the intervertebral disc also swells and shrinks back to its physiological position piece by piece, heavy lifting can lead to renewed prolapse at any time. Furthermore, through the puncture site Germs get into the spinal canal, which can lead to further inflammation. However, this complication can largely be prevented through sterile work.
You can find out more about the topic here: Cortisone therapy for a herniated disc

A distinction is made between different methods of administering a cortisone injection into the spine:

First, the paravertebral injection, which is used in a herniated disc and in which the cortisone next to the vertebral bodies is injected.

Secondly, the epidural injectionin which the syringe immediately into the spinal canal is injected.

Which of the two methods is used has to be decided on a case-by-case basis and also depends on the type of disease. In any case, the injection consists of a mixture of cortisone and a local anesthetic - this minimizes pain. Patients feel a slight sting, if at all, but this bears no relation to the severe pain for which patients usually seek treatment.

Read more on the topic Therapy of herniated disc

Cortisone injection for back pain

At a Injection in the back the doctor aims to treat the muscles, veins or joints. The cortisone injection is always mixed with a local anesthetic, which is supposed to break through the painful cramping and relieving of the muscles. But Experts | are divided opinion about the effectiveness of this form of therapy. There is no scientifically proven added value of applying cortisone or narcotics to the muscle itself. Even more, there is a risk of triggering an allergic reaction by applying it to a vein and has occasionally led to states of shock and death.

It therefore becomes a systemic therapy With Painkillers (NSAIDs’S) recommended, in combination with warmth and gentle exercise.

Read more on the topic Therapy of back pain

Cortisone injection on the knee

A cortisone syringe is also used on the knee if all other forms of therapy have failed. in the 4 weeks apart a dose of cortisone / painkiller mixture is injected into the knee using a syringe and local anesthesia.

There is an immediate improvement in pain scientifically proven, but this is only from short duration: After four weeks at the latest, the pain is back and you have to go to the doctor again. But the syringes are relatively cheap at € 5-10 per injection and are also covered by health insurance.

However, the syringes do not offer a permanent solution, and the freedom from symptoms is bought at the cost of a number of side effects. The risk-benefit ratio of the cortisone injection is often assessed by doctors as too poor.

Cortisone injection on the wrist

Even smaller joints like that wrist can be treated with a cortisone injection. The injection will directly into the joint injected and usually consists of a cortisone-anesthetic mixture. It is found on the wrist especially in the course of a Carpal tunnel syndrome Use in which the muscle and tendon box swells and is compressed at wrist level. In addition, a nerve running there, the median nerve, is compressed. Since the hand flexors are limited to the surface by a tight tendon, the flexor retinaculum, the compression results in a loss of function - the hand can no longer be bent.

Of which are especially women shortly after pregnancy affected. You can be helped with a cortisone injection until the hormone balance has returned to normal. As with all other joints, the injection only lasts a few weeks and then has to be repeated if necessary. The main risk here is also an infection after insufficient disinfection of the puncture site.

Cortisone injection for tennis elbow

Epicondylitis, also known colloquially as tennis elbow, is an overload of the tendons and muscles of the arm. It does not necessarily have to occur after playing tennis and can have a number of other causes that are associated with strong mechanical stress. As a rule, however, the pain radiates from the elbow and, in advanced stages, spreads to the wrist. The outside is usually more affected than the inside.

The procedure for tennis elbow does not differ from therapy for other joints: An individually tailored mixture of cortisone and a local anesthetic is injected into the elbow joint. The duration of the effect is 1-2 months, the short-term freedom from 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, it was investigated which of the two groups exhibited fewer symptoms over the long term. Interestingly, after 12 months of therapy, the cortisone injection group reported a lower level of freedom from symptoms on average than the placebo group, which received no active ingredient at all.
Experts attribute this to the fact that the rapid pain relief in the cortisone syringe group led the patient to put weight on the arm more quickly, which worsened the symptoms in the long term.

Pain is the body's way of signaling to the brain that a particular movement or strain is not healthy. So even if they are extremely uncomfortable, they still make sense. Accordingly, it does not always make sense to completely switch off the pain, as the above study shows. In practice, people have switched to using cortisone injections only for illnesses where the end of treatment is foreseeable - for example after pregnancy.

Read more about tennis elbow therapy

Corstison injection for osteoarthritis

At a arthrosis is it a Joint wear from too long or too heavy a load. It typically occurs in old age or at obese patients on. The increased cartilage abrasion causes in the long run Pain, because the bones that meet in the joint are no longer padded. With the pain comes that Inflammatory response and the swelling, which exacerbates 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 to the pain fibers.

For therapy, a little of the synovial fluid is therefore first punctured from the joint and the cortisone syringe is injected through the same puncture site. Since the cortisone is not ingested and metabolized orally, the extent of the side effects is less severe. However, in addition to the usual side effects such as worsening blood sugar and fat levels and increased susceptibility to infection, muscle wasting and joint cartilage damage also occur. This drastically worsens the symptoms in the long run, as a strong muscle tends to relieve the joint.

In the case of an incorrect injection into the surrounding fatty tissue, the fatty tissue can die, which can also be externally visible. This can occur especially with hip arthrosis, as access to the joint cavity is relatively difficult to find here.

Therefore, therapy with cortisone injections is not a permanent solution, even for osteoarthritis, but only a short-term alternative. Rather, a combination therapy consisting of physiotherapy, ointments and, in extreme cases, an operation should be considered. In hip osteoarthritis, either the joint is shifted in its axis (so-called conversion osteotomy) or the entire joint is replaced (total endoprosthesis / TEP, hip prosthesis).

Read more about osteoarthritis therapy

Side effects

Cortisone intervenes in the metabolism, more precisely in the formation of new sugar from fat. It mobilizes fat from its depots and converts it into sugar. Thereby blood lipid levels rise and the Blood sugar level. Sugar is harmful to blood vessels and organs. In combination with fats, they can last for a long time arteriosclerosis to lead. Since cortisone is also a blood pressure regulating Has an effect, it occurs as a result of the cortisone treatment Increases in blood pressure and water retention (Edema) into the tissue. This leads in addition to a relative Weight gain also to typical appearances like the "full moon face", a bull's neck and facial flushing.

Above are side effects Long-term effect and do not necessarily appear after the first treatment. However, therapies with cortisone injections only make sense over longer periods of time, as the effects wear off after a few weeks. The side effects of long-term therapy are thus given. The attending physician will always endeavor to keep the dose as low as possible and as effective as possible. But even with shorter periods of time there can be side effects, since cortisone has an immunosuppressive effect, i.e. that Slows down the immune system. This results in an increased susceptibility to infection and a possible feeling of illness.

In extreme cases, the therapy must be interrupted. Patients who already have an autoimmune disease (such as HIV) should be treated with special care.

Read more on this topic at: Cortisone side effects

prophylaxis

Joint damage in general can be prevented by using suitable equipment, for example suitable footwear while jogging or Trekking poles when hiking downhill. In obese patients, one should Weight reduction to think about nutrition plan. Furthermore, massages or a visit to an infrared cabin can relax the muscles. Sports that are gentle on the joints such as swimming or cycling can replace demanding sports such as squash or jogging.