Using Cortisone Injection and Steroid Shots for Inflammation

When Do You Need a Cortisone Shot?

Man receiving shot
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Corticosteroids are medications often used to treat inflammation. Most people refer to these medications as steroids, and when used as an injection, as cortisone. These words are often used interchangeably.


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 Injections Help 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 Improved by Cortisone

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

Strategies for Reducing Pain

A cortisone shot can be painful, especially when applied to 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. 

Side Effects 

Probably the most common side effect is a cortisone flare, a condition where the injected cortisone crystallizes and can cause a brief period of pain worse than before the shot.

This usually lasts a day or two and is best treated by icing the injected area.

Another common side effect is whitening of the skin where the injection is given. This is only a concern in people with darker skin and is not harmful, but you should be aware of this.

Other side effects of cortisone injections, although rare, can be quite serious. The most concerning is an infection, especially if the injection is given into a joint. The best prevention is careful injection technique, with sterilization of the skin using iodine and/or alcohol. Also, patients with diabetes may have a transient increase in their blood sugar which they should watch for closely.

Because cortisone is a naturally occurring substance, true allergic responses to the injected substance do not occur. However, it is possible to be allergic to other aspects of the injection, most commonly the betadine many physicians use to sterilize the skin.


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.


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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