Using Cortisone Shots for Inflammation

Learn about the benefits, side effects, and more

knee injection
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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 things you should understand before having an injection of this medication.

Natural vs. Synthetic Cortisone

Cortisone is a type of steroid closely related to a natural substance called cortisol. In your body, cortisol is produced in the adrenal gland and released when your body is under stress. Naturally produced cortisol is released into the blood stream and is relatively short-acting.

Injectable cortisone is synthetically produced and has many trade names (e.g. Celestone, Kenalog, etc.), but is a close derivative of your body's own product. The most significant differences are that synthetic cortisone is not injected into the bloodstream, but into a particular area of inflammation. Also, the synthetic cortisone is designed to act more potently and for a longer period of time (days instead of minutes).

Note that cortisone is not the same type of steroid as a performance enhancing drug. Not all steroids are the same! Types of steroids include cortisone, cholesterol, and sex hormones.

Therefore, if you go to your doctor's office and get a steroid shot, it will do nothing to grow muscles that you hear about with cheating in sports.

How Cortisone Helps Inflammation

Cortisone is a very powerful anti-inflammatory medication. It is not a pain relieving medication, it only treats the inflammation.

When pain is decreased from cortisone it is because the inflammation is diminished. By injecting the cortisone into a particular area of inflammation, very high concentrations of the medication can be given while keeping potential side-effects to a minimum. Cortisone injections usually work within a few days, and the effects can last up to several weeks.

In addition to injected cortisone, many physicians will mix the cortisone with another medication that may provide pain relief effects. For example, orthopedic surgeons will often mix cortisone with a local anesthetic to provide both immediate and longer-lasting pain relief. In addition, that added anesthetic can be helpful from a diagnostic standpoint. If the pain relief occurs quickly, your doctor will know the local anesthetic was delivered to the right location, and therefore the cortisone will also be in the right spot.

Conditions That Cortisone Helps

Many conditions where inflammation is an underlying problem are amenable to cortisone shots. These include, but are certainly not limited to

Reducing Pain

A cortisone shot can be painful, especially when given into a joint, but in skilled hands it usually is well tolerated.

Often, the cortisone injection can be performed with a very small needle that causes little discomfort. However, sometimes a slightly larger needle must be used, especially if your physician is attempting to remove fluid through the needle prior to injecting the cortisone. Numbing medication, such as Lidocaine or Marcaine, can be injected with the cortisone to provide temporary relief of the affected area. Also, topical anesthetics can help numb the skin in an area being injected. Cortisone injections administered to larger joints are generally very well tolerated, whereas injections into small joints or tight spaces may be much more uncomfortable.

For this reason, injections into the finger joints, feet, and tendons tend to cause much more discomfort than a shot into the shoulder or knee. 

Potential Side Effects

Like any drug, there are possible reactions, side-effects, and complications that can occur with a cortisone injection. Some doctors often 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 targeted injection is absorbed by the body. And since the body actually produces cortisone naturally, most people do not experience systemic effects. Those who do have symptoms of something may experience the following problems:

  • 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 blood glucose levels. Patients taking insulin should be especially careful, checking their blood sugar often and adjusting the insulin doses, if necessary. If the blood sugar rises more than anticipated, you should contact the physician who manages your diabetes to see if additional treatment is 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 who receive a cortisone shot. This can begin within a few hours of the injection and may last for a few days. Many doctors are unaware of how common this reaction is, and some may not appreciate how this can be upsetting to patients. The good news, is that these symptoms do spontaneously resolve, but it may make patients think twice before having another shot.

Local Side Effects

Local side effects are those that are only experienced in the one area of the body where the injection occurred. The local side effects of a cortisone injection are also rare, but again, they do occur and you should know what to do if they happen to you!

  • Pain and ​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 the Shots 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. Many doctors will offer an injection as they are quick, easy, and most often effective. However, your doctor should also be able to offer other treatments for inflammation that may also be effective for those that cannot have, or don't want, a cortisone injection.

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. This may influence whether or not you have another injection for the same or a different problem.

Treatment Plan

There is no rule as to how many cortisone injections can be given. Often, physicians do not want to give more than three, but there is not really a specific limit to the number of shots. However, there are some practical limitations.

If a cortisone injection wears off quickly or does not help the problem, then repeating it may not be worthwhile. Also, animal studies have shown effects of weakening of tendons and softening of cartilage with cortisone injections. Repeated cortisone injections multiply these effects and increase the risk of potential problems.

For these reasons, many physicians limit the number of injections they offer to a patient. The most common number physicians tell their patients is that no more than three injections should be administered in the span of a year, in one location of the body. That said, there are physicians who use more cortisone than this, and others who are more judicious about administering steroid shots. Discuss with your doctor how often you should (or could) have an injection.

A Word From Verywell

Many people have strong feelings about cortisone injections, if they're magic, if they're horrible, and if they should be used. Here's the bottom line: cortisone can be a very powerful tool that can be an excellent treatment, but is probably overused as a treatment for too many conditions, too frequently.

Cortisone should only be used to treat inflammation, not just injected for pain. It should be used sparingly, especially in younger people with healthy joints and tendons. It should be used with great caution in specific circumstance, such as around tendons that may become damaged. Lastly, physicians should be aware of the side-effects of a cortisone shot and inform their patients about these possible risks of having a shot of cortisone. If they don't, be sure to bring up these points of discussion.

Sources:

Hepper CT, at al. The efficacy and duration of intra-articular corticosteroid injection for knee osteoarthritis: a systematic review of level I studies. J Am Acad Orthop Surg. 2009 Oct;17(10):638-46.

Koester MC, Dunn WR, Kuhn JE, Spindler KP. The efficacy of subacromial corticosteroid injection in the treatment of rotator cuff disease: A systematic review. J Am Acad Orthop Surg. 2007 Jan;15(1):3-11.

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