[TheForge] blacksmith's elbow and cortizone

[Clyde Wynia]

Here is an email I received from a retired doctor friend after I sent him
the cortisone piece:
DEAR CLYDE,
    REMEMBER THAT PEOPLE WHO DON'T HURT DON'T PAY ATTENTION TO DOCTOR'S
ORDERS ABOUT AVOIDING INJURIOUS ACTIVITY.
    IMAGINE LONG LASTING NOVOCAINE FOR A SPRAINED ANKLE.  THE PATIENT GOES
OUT AND WALKS ON A PLOWED FIELD(TOUGH ON ANKLES).  WHAT WILL IT FEEL LIKE
WHEN THE NOVOCAINE FINALLY WEARS OFF. (WORSE LATER ON.)
    I'LL BET THEY DIDN'T TAKE AN ACTIVITY HISTORY(VERY HARD TO DO, PEOPLE
ALWAYS SAY THEY FOLLOWED DR'S ORDERS.)
    IF I GET ONE OF THOSE, I'LL TAKE CORTISONE IF IT'S OFFERED.
    MY SHOT IN THE KNEE HAS HELPED A GREAT DEAL.
SANDY(NOT EMPLOYED BY THE CORTISONE COMPANIES) MACDONALD

from NY times

But a major new review article 
<http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2961160
-9/abstract>, 
published last Friday in The Lancet, should revive and intensify the 
doubts about cortisone's efficacy. The review examined the results of 
nearly four dozen randomized trials, which enrolled thousands of people 
with tendon injuries, particularly tennis elbow, but also shoulder and 
Achilles-tendon pain. The reviewers determined that, for most of those 
who suffered from tennis elbow, cortisone injections did, as promised, 
bring fast and significant pain relief, compared with doing nothing or 
following a regimen of physical therapy. The pain relief could last for 
weeks.

But when the patients were re-examined at 6 and 12 months, the results 
were substantially different. Overall, people who received cortisone 
shots had a much lower rate of full recovery than those who did nothing 
or who underwent physical therapy. They also had a 63 percent higher 
risk of relapse than people who adopted the time-honored wait-and-see 
approach. The evidence for cortisone as a treatment for other aching 
tendons, like sore shoulders and Achilles-tendon pain, was slight and 
conflicting, the review found. But in terms of tennis elbow, the shots 
seemed to actually be counterproductive. As Bill Vicenzino, Ph.D., the 
chairman of sports physiotherapy at the University of Queensland in 
Australia and senior author of the review, said in an e-mail response to 
questions, "There is a tendency" among tennis-elbow sufferers "for the 
majority (70-90 percent) of those following a wait-and-see policy to get 
better" after six months to a year. But "this is not the case" for those 
getting cortisone shots, he wrote. They "tend to lag behind 
significantly at those time frames." In other words, in some way, the 
cortisone shots impede full recovery, and compared with those ''adopting 
a wait-and-see policy," those getting the shots "are worse off." Those 
people receiving multiple injections may be at particularly high risk 
for continuing damage. In one study that the researchers reviewed, "an 
average of four injections resulted in a 57 percent worse outcome when 
compared to one injection," Dr. Vicenzino said.


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