What are Cortisone / Corticosteroids Injections?
As a pain management physician, one of the most powerful tools in my arsenal against pain is a steroid injection, also known as a “cortisone injection” or “corticosteroid injection”. Cortisone is a powerful anti-inflammatory medication that reduces the inflammatory response of many painful conditions including arthritis, tendinitis, bursitis, and sciatica, to name a few. For the treatment of numerous painful spine conditions, one of the most successful and potent treatments is an epidural steroid injection.
To remember: One of the most common misconceptions about corticosteroid shots among patients is that they think that Cortisone is a pain relieving medication. Cortisone is an anti-inflammatory medication. After a cortisone injection, the pain decreases due to the reducing inflammation.
What are Cortisone Injections used for?
Since cortisone injections are powerful anti-inflammatory medications, they can be used as Local Cortisone Injections to reduce the inflammation of small areas of the body or as Systemic Cortisone Injections to reduce widespread inflammation of the body. Below in this post, we’ll also discuss about the side effects of both local and systemic steroid shots.
Local cortisone injections can help with bursitis, tendinitis, and with joints (arthritis). As a matter of fact, steroid injections are a frequently used to treat joint inflammation for many arthritic patients. Treatment is not the only reason why cortisone injections are used. When used with anesthetics such as lidocaine, it can help to confirm a diagnosis.
Systemic cortisone injections, which are usually given intramuscularly (gluteus or deltoid muscles), are used for conditions that affect the skin or many joints at the same time such as rheumatoid arthritis, allergic reactions and asthma. In order to treat even more severe conditions, this injections can be administered intravenously.
Cortisone Injections Common Questions
Some patients are concerned about the use of cortisone in their body. The most common questions they ask about the use of this type of steroid injection help us to conclude that is a great level of concern about the use of cortisone shots and if they are indeed bad for one’ body:
- Isn’t cortisone unnatural?
- Won’t cortisone injections harm my bones and cartilage?
- Will cortisone shots cause my tendons to rupture?
- Aren’t cortisone injections painful?
- Are corticosteroids the same as cortisone?
- If I already received a previous cortisone injection and it didn’t work, why will this one be different?
- What are the side effects of cortisone injection and the possible reaction to a cortisone shot?
In response, cortisol is a potent hormone called glucocorticoid that is produced naturally by the body. Along with adrenaline, cortisone is one of the two main hormones released by the adrenal gland in response to stress. Cortisone suppresses the immune system, thus reducing inflammation and its corresponding pain and swelling at the site of an injury.
Anti-inflammatory medications can be taken orally, but this distributes the medication in very diluted dosages throughout the entire body. A steroid injection, on the other hand, places a concentrated dose of medication directly at the site of the injury and the source of the pain, making it a very potent treatment.
To clarify about the nature of corticosteroids, it refers to a class of cortisone related medications known for reducing inflammation. Cortisone is a common type of corticosteroid, thus explaining why most people or healthcare professionals used both terms interchangeably.
Cortisone injections are very safe to perform and should always be performed by a properly trained and experienced physician or other health care professional. With the advancement and availability of modern imaging technology including mobile ultrasound and fluoroscopy, it is recommended that most injections be performed under direct image guidance to maximize both the efficacy and safety of the injection.
Please find below some of the most common known cortiscoteroids injections pros and cons so you can be able to determine if it is a viable option for you. When a physician recommends a treatment – including steroid injections -, it is not based only on the condition itself, but on the patient’s personal goals and predisposition as well since every patient is different.
Regarding a patient reaction to a cortisone shot as well as its possible side effects, please keep reading below to further understand them.
Cortisone Shots Pros
Some of the well known cortisone injections advantages:
- Cortisone is a naturally occurring substance
- Cortisone injections are easy to administer and well tolerated
- Cortisone injections have few side effects
- Side effects of cortisone injections tend to be minor and rare
Cortisone Shots Cons
Side effects of cortisone injections tend to be rare and minor. However, they do exist and potential patients tends to wonder the most about the potential side effects of a cortisone shot prior to deciding on moving forward to it.
Cortisone Injection Side Effects
Then again, this is one of the main concerns of a patient when it comes to the procedure. To better understand the possible side effects of a cortisone injection as well as a patient’s possible reaction to a cortisone shot, we divided them based on the body targeted areas by local side effects and systemic side effects. Potential side effects of a cortisone shot include the following:
1. Local Side Effects
- Some people experience local discomfort after an injection and may have an increase in pain for 24-48 hours post-injection. This is called a “cortisone flare” and usually subsides quickly.
- Whenever there is a break in the skin, as in during an injection, there is a risk of infection. The doctor should always sterilize the skin to minimize the risk of infection and use gloves.
- High doses of cortisone may have detrimental effects on joint cartilage and tendons.
- In older patients with worn-out or damaged joints and tendons, the concern is much less. Caution should generally be exercised in young, healthy individuals with otherwise pristine joints.
- Cortisone may also weaken tendons; therefore many doctors will use tendon-specific cortisone injections sparingly, especially the achilles tendon which is particularly prone to rupture with repeat injections.
2. Systemic Side Effects
Although steroid injections are a local, targeted treatment, a small amount of the steroid may be absorbed into the bloodstream and distributed throughout the body. And since the body actually produces cortisone naturally, most people do not experience systemic side effects from cortisone injections.
- The most common systemic reaction is seen in diabetic patients an a temporarily elevated blood sugar. Diabetic patients, especially those taking insulin, should monitor their blood sugar after an injection and adjust their insulin dose if necessary.
- Patients may experience facial flushing and redness after an injection. This reaction can begin within a few hours after an injection and may last for a few days. It is more common in women.
In summary, cortisone injections are extremely safe and effective treatments, but still do carry potential problems, most all of which are minor and rare. As with most other medical treatments, the key to the success of a cortisone injection is a properly chosen patient candidate and condition, paired with an experienced and skilled doctor. If you have questions or concerns about having a cortisone injection, speak with your doctor.
I had a cortisone injection yesterday into my foot for actute tendonitis (living in Spain at the moment) this morning I woke up with such a hot face is this a side effect
I had a caudal epidural in my spine last Frid and have experienced facial flushing. Looked up online and said quite common side effect especially for woman. Apparently a small amount of the steroid can get in your system so hoping disappears soon as been 5 days now
I had an injection of kenalog for my neck last Thursday. I had been having an acute arthritis problem with my hands
and wrists also. I could not drive, brush my teeth, and on and on.
While the injection was for my neck my hands are 90% normal. Amazed!!!!
So glad to hear this, I have AR too. Had experienced a flare up in my hands from Jan-mid March. I kept wanting to “wait and see” but doc finally talked me into Kenalog. Tough first few days but seem to be doing better this week. I had never heard of Kenalog 40 prior to this. Thanks for the post!
had a shot to my back had the red face flush for 6 days it made the pain bearable took the edge off in groin area after 3 weeks pain was there more then all of a sudden i got up to stand but could not stand or sit was in extreame pain from waist down had to be on hands and knees just waiting in pain after 4 minutes finally started subsiding then after 20 minutes gone like it never happen was the scariest thing
Cortisone injections are totally outdated and harmful to the area being applied. They may take some of the pain away for a little while but at a very high cost because it damages the tendons, ligaments and overall soft tissue where it is applied. Relapse of the injury occurs in most cases and makes it much harder to heal the area in the long term.
Doctors know it and can’t accept the fact that they are harming their patients by doing this or prescribe drugs to mask the pain which also harms the patient’s health and overall quality of life.
Nonsense… treatments are only outdated when there is a viable, affordable alternative of treatment. Tell me what is comparable to corticosteroids that is safe, effective and inexpensive. I doubt I’ll see a response.
they are “outdated” because the push isnt worth the squeeze you cant see inside the jont, but in the passing months where you had the injection will atrophy, in my case i had it leak into my soft tissue and can see the fat/ skin atrophy aswell. again this is permanent. 5 years. look at the scientific literature it has this same effect on bone cartilage muscle etc. you wouldn’t consider it if you knew how it works
Kimberly I was having same problem and ended up going to physical therapy for something else and told therapist what happened! She told me my (tailbone, coccyx,S1 joint etc ) was probably out of alignment! She gave me few exercises to do and voila pain is GONE!! I can actually go for a car ride longer than 20 mins!!
I had 2 injections already, one worked at bit, one not at all!!!
I had 2 steroid shots in the L5s1 areas. It was ‘ok’ but not great.
They suggested I have followup shots after 2 weeks passed.
I called for the appt. And was very saddened to hear… ‘we are sorry, Medicare only allows them after 3 months.’
Just enough time to totally lose any previous shot benefits.
I’m 66 … welcome to world of government knowing more than the Specialists.
My almost 88 yr old mom has bad arthritis in one of her knees, and just had a cortisone shot. I’m concerned this isn’t a good thing after reading so much negative press, and hearing the same.
Im 54 yeats old 5’9” 170# i have krones and it causes severe arthritis like symptoms but somehow my right knee has been a problem for the last three years once a year my family doctor would give me a Cortizone injection and I after three or four days had no pain Cortizone lasted me a good six months to seven I have now searched for a Doctor Who will treat this area I don’t qualify for surgery nor do I qualify for any other anti-inflammatories since we have tried all of them. Little left for me but think goodness everyone so down in against Cortizone and injection once a year that they are ready to condemn it is though their opinion is above that of all medical research even the doctors who are afraid of constantly being sued so now getting one short of a miracle I want it worked absolutely amazing with zero side effects for me
No thanks to a lot of people being quick to be negative saying their symptoms would be that of all people my success will never happen again I cannot believe people’s opinions seem to all be so negative
I am wondering how long a typical cortizone shot will last. I had one that lasted i day. I s there a chance that my next one will last substantially longer?
The immediate effect is usually from the local anesthetic injected which wears off in a few hours. The cortisone shot effect can last for several days to a few months. The effects depend on the actual condition and also vary from patient to patient.
I have had shots from Dr in shoulder that hat little effect because they are put in blind but go to hospital and have ultra sound guided one you can’t believe the difference. It may not cure it but gives months of relief
Interesting. My doctor performs a extensive movement test and can pinpoint the injection site from that. My first shoulder injection lasted 1.5 years and I just received a second with great results.
I have had 2 cortisone injections in my knee, one in mid March and mid June. At present, I am pain free. However, at the slightest bump, my skin will either tear open or a “blood bruise” will come up. Has anyone else had this problem?
cortizone irreversibly atrophy tissues, i had/have this 5 years later, maybe slight improvement in the skin weakness
had a cortisone injection march 8 2018 woke up with burning flushed face lasted all day ,Since the last 6months have woken at least twice a night with red hot swollen face ,feeling light headed. have to get up too try to cool down.Not getting any proper sleep..Nobody seems to know why or what to do to stop it. Have had tests done by Endicrimolagy which proved negative. Now waiting for an Imuneolgy appointment which may be a wait until January to march 2019.’What else can I do? desperate
I developed tennis elbow in March of this year. I received a cortisone injection in April. By May I was feeling awesome and decided to go back to weightlifting but with lower weights. I went to an orthopedic in September because my elbow didn’t look right. I was informed that the cortisone will reduce the fatty tissue causing the area to look funny. I had an MRI which showed a 50% tear in the lateral epicondyle tendon.
My question is….could I have torn this tendon will still under the effects of the cortisone injection and not feel the tearing? Or, is it more than likely that I did this before the injection? Hope this makes sense.
I was taking Cipro in the spring of 2017, and started to have discomfort in my left heel/low calf area, without any known over-use, injury, or previous injury. I mentioned this to my wife, a Neurologist, and she said I should stop taking it, as that class of antibiotics has a known, if unusual effect of weakening tendons. I did stop, and after several more days the discomfort advanced to Achilles tendonitis – swelling, tenderness, pain on applying pressure to my forefoot when, for example, climbing stairs or balancing on my affected foot. After a month or two, I decided to request a steroid injection of my primary care physician. He assented, to be performed by a physician’s assistant. The assistant told me he was injecting the Achilles tendon sheath. I had no issues with the procedure, and he did not warn me about any precaution such as going easy on the ankle for a period. I did get relief and seemed to make a full recovery over the next few months. In December 2017 I started to have the discomfort again, and again without any known cause, with the possible exception of wearing a new pair of walking shoes that was a bit too tight around the rear of the heel. The tendinitis/tendinosis became full-blown within a few days. After some weeks, I again requested and got a second steroid injection. But this time, there was no benefit. Some weeks later, while icing the area, I froze the skin, and perhaps some deeper tissue, using a gel-type ice pack that turned out to be frozen to 27 deg F. At the time I was getting PT for the tendonitis, primarily passive and active calf stretching, massage, dry pin stimulation, taping, and deep IR therapy, with eccentric stretch/exercise on a stair edge. I was gradually able to take more weight on the affected toe, and then one day I heard a “pop’, felt pain, and immediately sat down. At the time I understood that because the second steroid injection did not help, I probably did not have acute tendinitis, but a teninosis as a result of scarring and adhesions between the Achilles and nearby tissues, mis-alignmnent of the collagen fibers in the tendon, and general weakening of the tendon and the gastroc and soleus calf muscles. I found that I could still stand and walk OK, I could not feel any “loose ends” in the tendon or muscles. So I was in denial about having torn the Achilles – I hoped that the pop was “the bad stuff” letting go. But as the months pasted after that, I could not get stronger or put much pressure on my toe, so I went back the orthopod and PT. They confirmed that I have a significant, stage III tear in the Achilles, ~7cm opening on one side with muscle retraction, fluid collection, swelling, and weakness. So I was really blown away by the fact that the biggest tendon in my body could just break like that, and with no painful warning from my body leading up to it! This is really scary stuff.
I got recommendations from 2 athletes with foot problems to see a particular PT. He showed me the damage in real-time using ultrasound, watched me walk, palpated the tendon, heel and calf like the orthopod never did. He referred me to an MD who treats sports injuries with prolotherapy, platelet injections, and stem cell injections. He was very honest, and assured me that many injuries respond well to these therapies, and that not not all can. Surgery is sometimes necessary. My wife did a little research and says the published data is very ambivalent. The orthopod says the data is pretty sketchy, and she would not recommend it For Me.
So, this has lead me to a few conclusions:
– You’ve Got to read the inserts on your medications, so you are aware of possible side effects. Don’t rely on your doctor’s office to educate you.
– Steroids seem to be better for improving joint injury than tendons and ligaments.
– Don’t think you Know Better Than Anybody Else What Is Best For You. Ask questions.
And the experience has raised Lots of questions for me, having trained in the biological sciences and biomedical engineering, and being a life-long athlete. The tear occurred about 5 months ago. About 1 month ago I stopped doing the eccentric exercises and push-till -there-is-discomfort daily walks. So My Achilles feels better in general, but not very sturdy.
So, Questions:
1) Is there some time point, after the second steroid injection, at which I should try the exercised again?
2) Is it worth the $3000 price tag to try the regenerative therapy, if I feel like I can afford it?
I believe doctors are careless with their use of cortisone injections and many prescribe them with very little understanding of how they can wreak havoc on your body. What would be the purpose of prescribing these injections if their are no signs of inflammation in the body? I was given three within a 6 month period that resulted in a cushingoid like syndrome, a misdiagnosis of Grave’s disease and a ruptured tendon in my hand. they even injected a joint that was perfectly intact because of a lifelong wrist deformity (painless) claiming that it was caused by arthritis even when no tests revealed joint damage, any arthritic condition,inflammation or injury. These injections have now made me disabled and caused serious side effects that most of the doctors that prescribed them disclaim even when the manufactures clearly warn of these possibilities. Who is educating these doctors in pharmacology?