What is a cortisone injection

Cortisone injection also called corticosteroid injection may help relieve pain and inflammation in a specific area of your body. Cortisone injections are most commonly injected into joints — such as your ankle, elbow, hip, knee, shoulder, spine and wrist joints. Even the small joints in your hands and feet might benefit from cortisone injections. Cortisone injections can also be given into a bursa or tendon.

Cortisone injections usually comprise a corticosteroid medication and a local anesthetic. Often, you can receive a cortisone shot at your doctor’s office. Because of potential side effects, the number of cortisone injection you can receive in one year generally is limited.

The steroid damps down immune system overactivity in the area and reduces inflammation. This in turn helps to relieve the pain and swelling.

Cortisone injections usually help relieve pain and swelling, and make movement easier. The benefits can last for several months.

Cortisone injections are only available on prescription. They’re usually given by a specially trained doctor in a his surgery or hospital clinic.

Bursa

A bursa is a sac filled with fluid that acts as a cushion between tendons, bones, and joints. Swelling in the bursa is called bursitis. Using a small needle, your provider will inject a small amount of cortisone and a local anesthetic into the bursa.

Joint

Any joint problem, such as arthritis, can cause inflammation and pain. Your provider will place a needle in your joint. Sometimes ultrasound or an x-ray machine may be used to see where exactly the location is. Your provider may then remove any excess fluid in the joint using a syringe attached to the needle. Your provider will then exchange the syringe and a small amount of cortisone and a local anesthetic will be injected into the joint.

Tendon

A tendon is a band of fibers that connects muscle to bone. Soreness in the tendon causes tendonitis. Your provider will put a needle directly adjacent to the tendon and inject a small amount of cortisone and a local anesthetic.

You will be given a local anesthetic along with the cortisone injection to relieve your pain right away. The steroid will take 5 to 7 days or so to start working.

Cortisone injection key facts

• Cortisone injections for joint pain work by releasing the medicine slowly into the joint. This reduces pain and swelling.
• After a cortisone injection, your joint may feel better for several months – sometimes as long as a year.
• Some people get increased pain and swelling in the joint where the injection was given. This pain tends to go away after a few days.
• Cortisone injections into the same place can be repeated up to 4 times a year – more often can cause long-term joint damage.
• Cortisone injections can sometimes damp down your immune system so you’re more likely to get infections. Tell your doctor if you come into contact with chickenpox, shingles or measles. If your immune system is damped down, these infections could make you very ill.

Who can and can’t have cortisone injections

Adults and children can have cortisone injections.

Cortisone injections aren’t suitable for some people. Tell your doctor before starting the medicine if you:

• have ever had an allergic reaction to cortisone or any other medicine
• have ever had depression or manic depression (bipolar disorder) or if any of your close family has had these illnesses
• have an infection (including an eye infection)
• are trying to get pregnant, are already pregnant or you are breastfeeding
• have recently been in contact with someone with shingles, chickenpox or measles (unless you’re sure you are immune to these infections)
• have recently had, or will soon have, any vaccinations

Cortisone can make some health problems worse so it’s important that your doctor monitors you.

Make sure your doctor knows if you have:

• any unhealed wounds
• high blood pressure
• diabetes
• an eye problem called glaucoma
• weak or fragile bones (osteoporosis)

If you have diabetes and monitor your own blood sugar, you will need to do this more often. cortisone injections can affect your blood sugar control.

Limits on the number of cortisone injections

There’s concern that repeated cortisone injections might cause the cartilage within a joint to deteriorate. So doctors typically limit the number of cortisone injections into a joint.

In general, you shouldn’t get cortisone injections more often than every six weeks and usually not more than three or four times a year.

How and when to have cortisone injection?

A specially trained doctor usually gives the injection. If the injection is for pain, it may contain a local anaesthetic. You may also have a local anaesthetic by spray or injection to numb the skin before the cortisone injection.

You can go home after the injection but you may need to rest the area that was treated for a few days.

You can have a cortisone injection into the same joint up to 4 times in a year.

If you have arthritis, this type of treatment is only used when just a few joints are affected. Usually, no more than 3 joints are injected at a time.

The dose of cortisone injected depends on the size of the joint. It can vary between 5mg and 50mg of cortisone.

How well do cortisone injections work?

Cortisone injections usually help with pain and swelling for around 2 months. They can also make movement easier.

If you have a short-term joint injury, an injection will often help you start to move again so that your body can heal itself.

For long-term joint pain, an injection should help for a few months, but you may need further injections.

When will I feel better?

A cortisone injection usually takes a few days to start working – although sometimes they work within a few hours.

How many cortisone injections will I need?

If your pain and swelling gets better after a single cortisone injection, you may not need another one.

If you have a long-term problem and cortisone injections work well, you may carry on having them.

Doctors usually recommend that you shouldn’t have a cortisone injection into the same joint more than once every 3 months.

Will the cortisone injection dose I have go up or down?

The amount of cortisone in the injection could go up or down in future. It depends on how well the previous injection worked, how long the benefits lasted and whether you had any side effects.

Does cortisone injection hurt?

Cortisone injection can be a little uncomfortable but many people say they’re not as bad as they thought they would be.

Why do I need to be careful of infections?

Cortisone injections can sometimes damp down your immune system so you’re more likely to catch infections such as flu, the common cold and chest infections.

Keep away from people with infectious diseases, especially chickenpox, shingles or measles. If you’ve never had these illnesses they could make you very ill.

Tell your doctor straight away if you come into contact with someone who has chickenpox, shingles or measles. Your doctor may be able to prescribe a medicine to protect you.

Can I have vaccinations?

Before you have a vaccination, mention to the healthcare professional that you’re taking a steroid.

It’s possible that if you have a ‘live’ vaccine around the time that you have a cortisone injection, your immune system might not be strong enough to handle it. This could lead to you getting an infection.

Live vaccines include:

• shingles vaccine
• BCG (tuberculosis) vaccine
• yellow fever vaccine
• MMR (measles, mumps and rubella) vaccine
• nasal spray flu vaccine

Inactive vaccinations, like the injected flu vaccine, are safe.

If you need to have a live vaccine, check with the nurse or doctor that it’s safe for you.

Will cortisone injection affect my fertility?

Cortisone injections do not affect the fertility of men or women.

Will cortisone injection affect my contraception?

Cortisone injections do not interfere with any types of contraception, including the combined pill or emergency contraception.

Is cortisone injection safe during pregnancy and breastfeeding?

It’s usually OK to have a cortisone injection while you’re pregnant or breastfeeding.

However, cortisone has occasionally been known to cause problems in the first 12 weeks of pregnancy.

Tell your doctor if you’re trying to get pregnant or if you’re already pregnant before having a cortisone injection.

Cortisone injections and breastfeeding

It’s safe to have cortisone injections while you’re breastfeeding. Only very small amounts of cortisone get into breast milk so it’s unlikely to be harmful.

Are other treatments available?

There are a other types of medicine for swollen or painful joints. You could try an everyday painkiller like acetaminophen or ibuprofen.

There are also painkilling creams such as ibuprofen, diclofenac, or capsaicin cream. You massage these into the skin over the painful area.

If these treatments don’t work, your doctor can prescribe stronger painkillers such as naproxen and codeine.

Other options which can help sore or swollen joints.

It might help to:

• improve your general fitness through regular exercise
• do an exercise programme to increase muscle strength around your joint
• apply hot and cold treatments to the joint
• use a walking stick to support yourself
• have electrotherapy (for example a TENS machine)

It’s best to ask for expert advice from a physiotherapist or occupational therapist.

Cortisone injection indications

Cortisone injections are used to treat swollen or painful joints, such as after an injury or in arthritis.

Cortisone injections may be most effective in treating inflammatory arthritis, such as rheumatoid arthritis. Cortisone injections can also be part of treatment for other conditions, including:

• Bursitis (when a small bag of fluid which cushions a joint gets inflamed)
• Gout
• Plantar fasciitis
• Psoriatic arthritis
• Reactive arthritis
• Rheumatoid arthritis
• Tendinitis

How you prepare for cortisone injection

If you take blood thinners, you might need to stop taking them for several days before your cortisone injection to reduce your bleeding or bruising risk. Some dietary supplements also have a blood-thinning effect. Ask your doctor what medications and supplements you should avoid before your cortisone injection.

During the cortisone injection

Your doctor might ask you to change into a gown. You’ll then be positioned so that your doctor can easily insert the needle.

The area around the injection site is cleaned. Your doctor might also apply an anesthetic spray to numb the area where the needle will be inserted. In some cases, your doctor might use ultrasound or a type of X-ray called fluoroscopy to watch the needle’s progress inside your body — so as to place it in the right spot.

You’ll likely feel some pressure when the needle is inserted. Let your doctor know if you have a lot of discomfort.

The medication is then released into the injection site. Typically, cortisone injections include a corticosteroid medication to relieve pain and inflammation over time and an anesthetic to provide immediate pain relief.

After the cortisone injection

Some people have redness and a feeling of warmth of the chest and face after a cortisone injection. If you have diabetes, a cortisone injection might temporarily increase your blood sugar levels.

Cortisone injection takes little time to work. You can go home the same day.

After your cortisone injection, your doctor might ask that you:

• You might have slight swelling and redness around the injection site.
• Protect the injection area for a day or two. For instance, if you received a cortisone injection in your shoulder, avoid heavy lifting. If you received a cortisone injection in your knee, stay off your feet when you can.
• Apply ice to the injection site as needed to relieve pain. Don’t use heating pads.
  • If you have swelling, apply ice over the site for 15 to 20 minutes, 2 to 3 times per day. Use an ice pack wrapped in a cloth. DO NOT apply ice directly to skin.
• Watch for signs of infection, including increasing pain, redness and swelling that last more than 48 hours.
• Don’t use a bathtub, hot tub or whirlpool for two days. You may shower.
• Avoid a lot of activity the day you get the shot.

If you have diabetes, your doctor will advise you to check your glucose level more often for 1 to 5 days. The steroid that was injected can raise your blood sugar level, most often only by a small amount.

Look for pain, redness, swelling, or fever. Contact your doctor if these signs are becoming worse.

Cortisone injection side effects

Most people don’t have any side effects after a cortisone injection. Side effects are less likely if only one part of the body is injected.

Cortisone injection side effects may include:

• Pain and bruising at the site of the injection
• Swelling
• Irritation and discoloration of the skin at the injection site
• Allergic reaction to the medicine
• Infection
• Joint infection
• Bleeding in the bursa, joint, or tendon
• Nerve damage near the joint or soft tissue
• Temporary increase in your blood sugar level for several days after the cortisone injection if you have diabetes
• Thinning of skin and soft tissue around the injection site
• Temporary flare of pain and inflammation in the joint
• Tendon weakening or rupture
• Thinning of nearby bone (osteoporosis)
• Whitening or lightening of the skin around the injection site
• Death of nearby bone (osteonecrosis)

Common side effects

The most common side effect is intense pain and swelling in the joint where the injection was given. This usually gets better after a day or two.

You may also get some bruising where the injection was given. This should go away after a few days.

Serious side effects

With cortisone injections, the medicine is placed directly into the painful or swollen joint. It doesn’t travel through the rest of your body. That means, it’s less likely to cause side effects. Sometimes, though, cortisone from a joint injection can get into the bloodstream. This is more likely to happen if you’ve had several injections.

If cortisone gets into your bloodstream, it can travel around your body and there’s a very small chance that you may have a serious side effect.

Call a doctor straight away if you get:

• depressed (including having suicidal thoughts), feeling high, mood swings, feeling anxious, seeing or hearing things that aren’t there or having strange or frightening thoughts – these can be signs of mental health problems
• a fever (temperature above 100.4 °F or 38 °C), chills, a very sore throat, ear or sinus pain, a cough, pain when you pee, mouth sores or a wound that won’t heal – these can be signs of an infection
• sleepy or confused, feeling very thirsty or hungry, peeing more often than usual, flushing, breathing quickly or having breath that smells like fruit – these can be signs of high blood sugar
• weight gain in the upper back or belly, a moon face, a very bad headache and slow wound healing – these can be signs of Cushing’s syndrome

You should also call a doctor straight away if you get:

• breathless
• swelling in your arms or legs
• changes in your eyesight

Some of these side effects, such as mood changes, can happen after a few days. Others, such as getting a rounder face, can happen weeks or months after treatment.

Children and teenagers

In rare cases, if your child or teenager has cortisone injections over many months or years, it can slow down their normal growth.

Your child’s doctor will watch their growth carefully while they are having cortisone injections. That way they will be able to see quickly if your child is growing more slowly and can change their treatment if necessary.

Talk to your doctor if you are worried about your child having cortisone injections.

Serious allergic reaction

It’s extremely rare to have an allergic reaction (anaphylaxis) to a cortisone injection but if this happens to you or your child, contact a doctor straight away.

How long does a cortisone injection last?

You may notice a decrease in your pain for the first few hours after the cortisone injection. This is due to the numbing medicine (local anesthetic). However, this effect will wear off.

After the numbing medicine wears off, the same pain you were having before may return. This may last several days. The effect of the cortisone injection will start usually 5 to 7 days after the injection. This can decrease your symptoms.

At some point, most people feel less or no pain in the tendon, bursa, or joint after a cortisone injection. Depending on the problem, your pain may or may not return. For some, cortisone injection can last weeks or months.