Cortisone Injections: Worth the Stick?
By Corinne VanBeek, MD
Cortisone shots are injections used to alleviate pain and decrease inflammation in a certain area of the body. They are frequently administered into joints, such as the knee, hip, ankle, and shoulder. Sometimes they are administered into other spaces, such as the subacromial space or the space above the rotator cuff of the shoulder. A wide variety of conditions can be treated with these injections.
Cortisone injections frequently consist of a steroid (the cortisone part) and a local anesthetic. The local anesthetic is similar to the novicaine a dentist may administer at the time of a dental procedure. The local anesthetic component of the injection works faster than the steroid and facilitates immediate relief before the steroid kicks in days later. Corticosteroid injections can be given in the doctor's office. Occasionally they are administered in the operating room for spine conditions.
Does the injection offer more than transient relief? Cortisone may alleviate pain and decrease inflammation for several months. For some conditions in which the pathology is localized to inflamed tissue, a cortisone injection may enable permanent resolution of the problem.
The number of injections you can receive annually is limited to three or four per year. This is because of the potentially deleterious effects of cortisone. Cortisone can deteriorate the cartilage in a joint and weaken tendons. Cortisone shots also carry other risks, such as skin discoloration and thinning around the injection site and temporary facial flushing. It is important to realize that cortisone shots can cause a transient flare up of pain and inflammation at the site of the injection. After 48 hours, a decrease in pain and inflammation should be experienced.
Because cortisone injections may accelerate joint deterioration and tendon degeneration, patients should think twice before getting the injection for temporary relief of pain. Researchers are still investigating the efficacy and safety profile of other types of injections, such as hyaluronic acid and platelet rich plasma, that may replace cortisone injections to alleviate pain and inflammation and possibly expedite healing.