The Cortisone Shot is Not Benign

What temporary relief may be costing your cartilage, tendons, bone, blood sugar, and future treatment options.

Author

Dr. Tammy Penhollow
October 13, 2026

Cortisone Can Quiet the Pain While Damaging the Tissue You Are Trying to Protect

Cortisone injections are commonly described as routine.

I do not consider them benign, and I do not use them in my musculoskeletal practice.

They can make pain and inflammation go quiet temporarily. But temporary symptom relief is not the same thing as healing, and corticosteroids have documented effects on cartilage, tendons, bone, blood sugar, adrenal function, and local tissue.

For me, that tradeoff does not make sense when my goal is to preserve tissue, improve the biological environment, correct the underlying diagnosis, and support long-term function.

A cortisone injection can suppress the signal.

It does not repair the reason the signal is there.

And in some circumstances, it can make the tissue environment worse.

“If my goal is to protect cartilage, tendon, bone, and the biology needed for healing, I am not going to inject something that works against those goals.”

Dr. Tammy Penhollow

Feeling Better Does Not Mean the Tissue Is Better

This is one of the most important distinctions I make with patients.

A knee can feel dramatically better after cortisone while the arthritis is still there.

A shoulder can hurt less while a damaged tendon remains damaged.

An elbow can become easier to use even though the tendon itself has not regained structural strength.

Pain is a signal.

Turning down that signal can be useful for comfort.

But turning down the signal does not necessarily change what is happening to the tissue underneath it.

In some cases, the medication used to suppress the signal may make that tissue environment worse.

Six Effects of Cortisone I Want Patients to Understand

1. Cartilage Toxicity

Cartilage cells are called chondrocytes.

They maintain the extracellular matrix that gives cartilage its structure and function.

Corticosteroids have demonstrated dose-dependent and frequency-dependent chondrotoxic effects, including effects on chondrocyte viability and cartilage matrix integrity.

That matters enormously when the joint being injected already has cartilage thinning or osteoarthritis.

You are trying to protect the cartilage you have left.

For me, injecting something capable of harming those cells works against that goal.

Pain relief and cartilage protection are not the same outcome.

2. Tendon Weakening and Rupture Risk

Tendons transmit force from muscle to bone.

Corticosteroids can alter collagen organization and tendon strength.

That creates a particularly concerning situation:

The tendon may feel better before it is structurally better.

Pain decreases.

The patient begins loading the tendon again.

But the tissue being loaded may actually be more vulnerable.

Tendon rupture after corticosteroid exposure is a recognized complication, particularly around structures such as the Achilles, patellar tendon, rotator cuff, biceps, and elbow tendons.

That is not a minor adverse effect.

A ruptured tendon can alter strength, movement, sport participation, work capacity, and independence.

3. Bone Is Part of the Equation

Corticosteroids affect bone metabolism.

They can suppress osteoblast activity, alter calcium metabolism, and favor bone resorption over bone formation.

The significance of one isolated injection is different from repeated or cumulative steroid exposure.

But that cumulative exposure matters.

I pay particular attention to this in people who already have osteopenia, osteoporosis, postmenopausal bone loss, inflammatory disease, or steroid exposure from other medical conditions.

Your knee injection does not exist in a vacuum.

Neither does your shoulder injection.

I want to know all of the steroid exposure your body has received.

4. Blood Sugar Can Rise

Corticosteroids increase glucose production and can impair insulin sensitivity.

For someone with normal glucose regulation, that increase may be temporary.

For someone with diabetes, prediabetes, insulin resistance, or a history of glucose instability, it can be much more meaningful.

That belongs in the informed-consent conversation before the injection.

A medication injected into a joint is not staying only inside that joint.

5. Cortisone Can Suppress Your Own Adrenal System

Your hypothalamic-pituitary-adrenal, or HPA, axis regulates your body's own cortisol production.

External corticosteroids signal that system to reduce its own output.

The effect is often temporary, but it is real.

The degree of suppression depends on the medication, dose, injection site, frequency, cumulative exposure, and the individual patient.

This becomes especially relevant when someone has received steroids in multiple locations over a relatively short period of time.

A knee.

Then a shoulder.

Then an epidural injection.

Then perhaps another joint.

Those exposures add up.

6. Local Tissue Atrophy Can Occur

Corticosteroids can also affect the tissue immediately around the injection.

Skin can thin.

Subcutaneous fat can atrophy.

Pigment changes can occur.

Visible depressions or contour changes sometimes develop around the injection site.

For some patients, those changes last.

Again, this is not simply a pain medication that disappears after it has done its job.

It has a biological footprint.

And There Is Another Risk I Think Patients Need to Know

This one is especially important for people with progressive knee, shoulder, or hip arthritis.

Sometimes cortisone injections are given repeatedly while a patient is moving closer and closer to joint replacement.

Then the surgeon finally says:

It is time.

But corticosteroid exposure can matter there too.

A 2023 systematic review and meta-analysis examining steroid injections before total knee replacement found that an intra-articular steroid injection given within three months before surgery was associated with approximately 26% higher odds of periprosthetic joint infection.

Other meta-analyses examining hip and knee replacement have also found increased infection risk when corticosteroid injections are performed during that three-month window.

Periprosthetic joint infection is not a small complication.

It can mean prolonged antibiotics, additional operations, implant revision, extended rehabilitation, and a very different recovery from the joint replacement the patient originally expected.

That risk matters to me because cortisone is frequently offered to the very patients who may ultimately progress to surgery.

The timing of what you inject today can affect the treatment you need tomorrow.

🎥 Continue Learning

The Cortisone Shot That Changed Everything ... And Not in the Way She Expected

In this video, I walk through what corticosteroids can do to cartilage, tendons, bone, blood sugar, adrenal function, and local tissue, and why I think patients deserve to know the entire picture before agreeing to an injection.

Watch here:

Read the Deeper Review

I also wrote a more detailed physician review of the evidence and the six tissue and systemic effects I consider when evaluating someone who has already received corticosteroid injections.

Why Corticosteroid Injections Are Not as Benign as You've Been Told

So What Do I Do Instead?

I am anti-cortisone in musculoskeletal care.

That does not mean every painful joint needs PRP or bone marrow concentrate.

It means I want to diagnose the problem rather than temporarily silence it.

If a joint is inflamed because it is mechanically unstable, I want to identify the instability.

If a tendon is overloaded because the kinetic chain is dysfunctional, I want to address the load.

If muscle loss is contributing to joint stress, rebuilding muscle matters.

If the biological environment is working against recovery, nutrition, metabolic health, sleep, hormones when appropriate, and other modifiable factors belong in the plan.

For selected patients, autologous orthobiologics such as PRP or bone marrow aspirate concentrate may have a role.

For others, rehabilitation or another conservative strategy may be the right answer.

And sometimes surgery is the correct treatment.

My objection is not to treating inflammation.

My objection is to repeatedly suppressing a symptom with a medication that can work against the very tissue we are trying to preserve when other approaches are available.

Prior Cortisone Does Not Mean You Are Out of Options

If you have already had cortisone injections, do not interpret this issue as a reason to panic.

It means the history matters.

When I evaluate someone who has previously received steroids, I want to know:

What was injected?
Where?
How much?
How many times?
When was the last injection?
How long did it help?
Did each injection provide less relief than the one before it?
And what does the tissue look like now?

A previous steroid injection does not automatically rule out regenerative care.

It changes the tissue assessment and sometimes the timing or sequencing of what comes next.

The goal is to work with the biology that exists today.

Supporting the Inflammatory Environment Without Pretending a Supplement Is a Drug

There is a major difference between using a corticosteroid to pharmacologically suppress inflammation and supporting a healthier inflammatory and recovery environment through nutrition, sleep, movement, metabolic health, and carefully selected supplementation.

That does not make turmeric “natural cortisone.”

I do not think about it that way.

And a supplement is not a treatment for osteoarthritis, a tendon tear, spinal disease, or another structural diagnosis.

But formulation quality matters.

And this is one of those situations where the formulation is genuinely interesting.

Use code PENHOLLOW at checkout for 5% off.

MEND Perform uses TurmiPure Gold®, a specialized turmeric extract designed to improve curcuminoid absorption.

Why is that important?

Because curcumin has notoriously poor oral bioavailability.

Simply putting a large number of milligrams of turmeric on a bottle does not tell you how much curcuminoid exposure you are actually achieving.

A randomized crossover pharmacokinetic study in 30 healthy adults compared several turmeric formulations.

Participants received, among other formulations, 300 mg of TurmiPure Gold and 1,500 mg of a standard 95% turmeric extract.

Over 24 hours, the TurmiPure Gold formulation produced approximately 24-fold greater dose-normalized curcuminoid bioavailability than the standard turmeric extract.

That is why I care about the formulation rather than simply looking at the number of milligrams on the label.

And an important distinction:

Greater bioavailability does not automatically prove a greater clinical treatment effect.

The study tells us much more of the curcuminoid formulation reached systemic circulation.

It does not mean MEND Perform treats arthritis, replaces medical treatment, or produces an effect equivalent to a corticosteroid injection.

MEND Perform also contains other ingredients selected to support recovery and normal inflammatory balance, including ashwagandha, tart cherry, and ginger. The company describes the product as third-party tested.

This is not a treatment for arthritis, tendon injury, or another musculoskeletal diagnosis.
It is one tool I may use to support the larger biological and recovery environment.

Quick Answers

Are cortisone injections bad for cartilage?

Corticosteroids have demonstrated dose-dependent and frequency-dependent harmful effects on chondrocytes and cartilage in research, and repeated intra-articular exposure is particularly concerning when cartilage is already compromised.

If cortisone made me feel better, does that mean it healed the joint?

No.

Reducing pain and inflammation does not mean cartilage, tendon, ligament, muscle, or another underlying structural problem has been repaired.

Why does the three-month window before joint replacement matter?

Studies have found a higher risk of periprosthetic joint infection when an intra-articular corticosteroid injection is given within three months before arthroplasty. One 2023 meta-analysis of total knee replacement found approximately 26% higher odds of infection in that window.

Can I still be evaluated for regenerative medicine if I have already had cortisone?

Yes.

Prior corticosteroid exposure does not automatically exclude someone from regenerative care. The injection history, timing, tissue condition, diagnosis, mechanical environment, and overall health all need to be considered.

Know What You Are Saying Yes To

Cortisone is only one example of why patients need to understand more than the name of a procedure.

PRP is not automatically appropriate because it is regenerative.

BMAC is not automatically appropriate because it contains cells.

Surgery is not automatically wrong because it is invasive.

And cortisone is not automatically benign because it is common.

The right decision begins with understanding what problem is actually being treated and what the proposed treatment does to the system around it.

That is why I created The Patient's Guide to Ethical Regenerative Medicine.

It explains what responsible regenerative care should look like, what questions to ask, what limitations patients should understand, and how to recognize when another treatment category may be more appropriate.

The Patient's Guide to Ethical Regenerative Medicine

The Bottom Line

Cortisone can make pain go quiet.

That does not mean the tissue is healthier.

Corticosteroids can affect cartilage, tendons, bone metabolism, blood sugar, adrenal function, and local tissue.

And if a joint replacement is approaching, an injection within the preceding three months may also increase the risk of a serious surgical infection.

So before agreeing to another cortisone injection, do not ask only:

“Will this help my pain?”

Ask:
What is actually causing the pain?
What is this injection doing to the tissue I am trying to protect?
What alternatives do I have?

And:
How might today's treatment affect the options I need tomorrow?

I am anti-cortisone in musculoskeletal care because my goal is not simply to silence a symptom.

My goal is to protect the system, preserve options, and treat the problem as precisely as possible.

To better movement,

Tammy J. Penhollow, DO
Architect of Spine and Joint Health
Precision Regenerative Medicine™
Structure First. Precision Always.

References

  1. Local and Systemic Side Effects of Corticosteroid Injections for Musculoskeletal Indications. American Journal of Roentgenology. 2024;222(3):e2330458. This review identifies local complications including skin atrophy, hypopigmentation, tendon rupture, infection, accelerated osteoarthritis progression, and osseous injury.

  2. Use and safety of corticosteroid injections in joints and musculoskeletal soft tissue: guidelines from the American Society of Regional Anesthesia and Pain Medicine, American Academy of Pain Medicine, American Society of Interventional Pain Physicians, and International Pain and Spine Intervention Society. Regional Anesthesia & Pain Medicine. 2025.

  3. Preoperative intra-articular steroid injections within 3 months increase the risk of periprosthetic joint infection in total knee arthroplasty: a systematic review and meta-analysis. 2023. Pooled odds ratio for injections within three months: 1.26, 95% CI 1.06-1.50.

  4. Prior Intra-articular Corticosteroid Injection Within 3 Months May Increase the Risk of Deep Infection in Subsequent Joint Arthroplasty: A Meta-analysis. Clinical Orthopaedics and Related Research. 2022.

  5. Fança-Berthon P, et al. Pharmacokinetics of a Single Dose of Turmeric Curcuminoids Depends on Formulation: Results of a Human Crossover Study. The Journal of Nutrition. 2021.

If someone you care about is being offered another cortisone injection without a clear conversation about what happens to the tissue afterward, please share this issue with them.

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