Now available on-line! The extensive collection of presentations by PERQUE founder Russell Jaffe, are now being made available on www.PERQUE.com.

We hope that having easy access to these valuable educational tools will be of value to you and your patients. 

Steroids: More Harm Than Good?

In the late 1940s, the steroid cortisone, an anti-inflammatory drug, was first synthesized and hailed as a landmark. Cortisone shots became one of the preferred treatments for overuse injuries of tendons, like tennis elbow or an aching Achilles, which had been notoriously resistant to treatment. The shots were quite effective, providing rapid relief of pain.

Even though an article in the '50s pointed out some negative aspects of cortisone, today cortisone shots remain a standard, much-requested treatment for tennis elbow and other tendon problems.

 A recent review article in The Lancet raises questions on cortisone safety and efficacy.  The review looked at the results of 48 randomized trials, covering thousands of people with tendon injuries including tennis elbow and Achilles-tendon pain. Over all, people who received cortisone shots had short term pain relief but 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. Those people receiving multiple injections may be at particularly high risk for continuing damage.

Click here for the NY Times article  

Click here for research abstract

For many years it was widely believed that tendon-overuse injuries were caused by inflammation. Cortisone being an anti-inflammatory medication, using it against an inflammation injury was logical. Cortisone injections seem to have an effect on the neural receptors involved in creating the pain in the sore tendon, but do not heal the structural damage underlying the pain. Instead, they actually impede the structural healing.        

Click Here to Read More