Page 100 - Athletic Health Handbook
P. 100
corticosteroid injections — a dosage
far greater than that which would
have been given on a clinical basis.
In the only primate study to date,
corticosteroid injections into the
knee produced minimal reversible
hyaline cartilage changes.13 In addi-
tion, a study by Jacoby et al17 found
no deleterious effects of clinical doses
of hydrocortisone on living human
cartilage explants.

Duration of Action

The effective duration of corticosteroid
medications is largely dependent
upon the solubility of the particular
agent.7,29 Intrasynovial injections are
absorbed at variable rates into the
systemic circulation based upon the
aqueous solubility of the steroid.
Insoluble agents remain at the injec-
tion site for a prolonged period of
time; therefore they possess a longer
duration of action (Table 1).7 Absorp-
tion into the circulation has been
reported to produce suppression of
the hypopituitary-adrenal axis for two
to seven days following injection. As
a result, some authors have cautioned
against injecting more than one large
joint per clinical encounter.21

Clinical Indications

Rheumatoid arthritis and osteoarthritis
are the most common indications for
corticosteroid injections. The anti-
inflammatory effects are purported to
allow for decreased pain which may
ultimately allow for increased activity
and a more rapid return to normal
function. If these medications are
utilized, they must be combined with
the appropriate rest period and reha-
bilitation program for the specific
injury being treated. Concern has
arisen that these medications may be
utilized simply to turn off the physi-
ologic “alarm-system” in order to allow
athletes to play, which ultimately may
lead to far greater injury to already
compromised tissues.24 Experimental
data in animals evaluating the effects

INJECTABLE CORTICOSTEROIDS 100
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