Cortisone Shot Side Effects

Possible Complications of a Cortisone Shot

injection shot shoulder
H. Armstrong Roberts/ClassicStock / Getty Images

Cortisone injections are used for treating many orthopedic problems including arthritis , tendonitis, and bursitis.  Cortisone is an anti-inflammatory medication, not a pain-killer. However, by reducing inflammation, pain often subsides.  Cortisone injections are very safe to perform. Side effects tend to be rare and minor. However, there are a few potential side effects of a cortisone injection that patients should know about.

In addition, often doctors are not keenly aware of the side-effects of cortisone as these tend to be limited (they resolve in a short amount of time) and your doctor may not see these effects as they tend to occur long after the patient has left the office.  Many patients feel as though their doctor doesn't care about these sometimes significant consequences of cortisone.  Therefore, it's important that patients be aware of the possible side-effects of any medication they take, and inform their doctor if these occur.

Systemic Side Effects

Systemic side effects occur as a result of a small amount of the cortisone entering the bloodstream and affecting your entire body, not just the location where the cortisone was given.

Systemic side effects of a local injection of cortisone are rare and usually minor. Unlike taking oral steroids, or having cortisone injected directly into the bloodstream, only a small amount of a local injection is absorbed by the body.

And since the body actually produces cortisone naturally, most people do not experience systemic effects. Those who do may experience:

  • Elevated Blood Sugar
    The most common systemic reaction is seen in diabetic patients. Patients with diabetes should carefully monitor their blood sugar as cortisone can cause a temporary rise in their levels. Patients taking insulin should be especially careful, checking their blood sugar often and adjusting the insulin doses, if necessary.
  • Facial Flushing
    Patients may experience flushing sensation and redness of their face. This reaction is more common in women and is seen in up to 15 percent of patients. This can begin within a few hours of the injection and may last for a few days.

Local Side Effects

Local side effects are those that are only experienced in one area of the body. The local side effects of a cortisone injection are also rare.

  • Pain & Cortisone Flare Reaction
    Some patients have discomfort after the injection and may experience an increase in pain 24 to 48 hours after being treated. This usually subsides quickly and can be aided with an ice pack and anti-inflammatory medication.
  • Infection
    Whenever there is a break in the skin, like when a needle is used to administer cortisone, there is a chance of infection. Your doctor will sterilize the skin to minimize the risk of infection.
  • Skin Pigment Changes
    Patients with darker skin should also be aware that cortisone may cause the skin around the injection site to lighten. This is not harmful.
  • Loss of Fatty Tissue
    High doses of cortisone can have detrimental effects on some tissues in the body. When injected into fatty tissue, cortisone can lead to a problem called fat atrophy. Fat atrophy causes loss of fatty tissue, which can lead to dimpling of the skin or the thinning out of fat. Patients who get cortisone injections in the heel to treat plantar fasciitis may find walking painful as fat that usually cushions their steps may thin out.
  • Tendon Rupture
    Cortisone can also cause weakening of tendons. This is one reason your doctor may limit the number of cortisone injections administered. Cortisone can also lead to tendon rupture, as is the case when cortisone is injected for Achilles tendonitis.

Are They Safe?

Cortisone injections are extremely safe, but they do still have potential problems. If you are concerned about having a cortisone shot, talk with your doctor. While cortisone is a powerful treatment for many orthopedic conditions, there are usually other options that can also be tried.

If you have had side-effects as a result of a previous cortisone injection, be sure to let your doctor know of the problem that occurred and the severity of the side-effect. 

Sources:

Cole BJ and Schumacher HR "Injectable Corticosteroids in Modern Practice" J. Am. Acad. Ortho. Surg., January/February 2005; 13: 37 - 46.

Fadale PD and Wiggins ME "Corticosteroid Injections: Their Use and Abuse" J. Am. Acad. Ortho. Surg., May 1994; 2: 133 - 140.

Continue Reading