Cortisone shots are another term for steroid injections, as cortisone is a type of corticosteroid. There are many different types of steroid injections that can be used for many different reasons. In general, cortisone shots are used for relieving painful conditions that are related to something going wrong in the musculoskeletal system, whether in a joint, a tendon, muscle or the spine.
Cortisone shots, also called steroid shots, are used to treat conditions in which there is pain related to inflammation, whether it's in a large joint such as the knee or shoulder or smaller joints as in the hand or ankle.
They can also be used for painful and inflammatory conditions from a herniated disc in the spine, whether it's in the lumbar spine (lower back), cervical spine (neck), or in the thoracic spine (middle back). Cortisone shots can also be used around joints in the spine known as “facet” joints to calm inflammation and reduce associated back or neck pain.
Cortisone shots can also be used for small, partial tears in muscles or tendons to help reduce pain and facilitate better rehabilitation during physical therapy. This may be done for shoulder rotator cuff issues, for meniscus issues and other knee-related issues, or for any sort of arthritic condition. They may also be used to calm inflamed nerves, such as the ulnar nerve in cases of cubital tunnel syndrome.
Cortisone works by decreasing the inflammatory response in the joint, muscle or other part of the body in which it is being injected. Typically, whenever there is inflammation, there is also a significant pain response. Therefore, if we can decrease the inflammation, we can usually decrease some of the pain. However, cortisone shots do not actually contain any sort of healing properties – their purpose is to relieve pain so that you can participate in rehabilitation more effectively, such as physical therapy, which is how the actual healing takes place.
Depending on the part of the body being treated, your physician may use image guidance, such as an ultrasound or X-ray, to direct the injection.
The key benefit of a cortisone shot is that it reduces the inflammatory response of an acute or chronic injury. This in turn enhances pain control, which will help you rehabilitate the injury. For example, it can help you bend your injured knee further or rotate your shoulder in a wider range of motion despite the painful issue that needs to heal. Being able to extend your range of motion for physical therapy or exercises performed at home will help rehabilitate the injury better and more quickly.
If you are already going through physical therapy, or if you've had ongoing pain for a certain amount of time (generally at least a few weeks), and the pain is not getting any better with conservative care such as ice, heat, or anti-inflammatory medications, that's generally when a type of cortisone shot might be recommended. This depends, however, on the diagnosis.
Cortisone shots can sometimes be painful, depending on which part of the body they're given. But the good news is that HSS doctors are experienced at reducing any pain from the injection itself by using smaller needles and by using local anesthesia. Sometimes there can be some pain associated with a cortisone shot after an initial increase in inflammatory response, but after around 24 hours the inflammation really improves.
In general, most people tolerate cortisone shots very well.
There can be some restrictions, depending on where on the body you’re receiving the shot. If you are getting a cortisone shot in the spine, your doctor might have different restrictions. For example, they may depend on how much time your doctor wants to give the cortisone shot to start working before you do more rehab. These decisions can also vary from doctor to doctor.
In general, the restrictions for these types of situations can range anywhere from 24 to 48 hours to up to a week. Usually, these restrictions mean avoiding extreme activity or extreme exercise, not basic activities such as going to the store or doing chores in the house.
For cortisone shots in other parts of the body, the restrictions are usually for a much shorter time period. This all depends on the particular injury that is being treated, when we want the patient to get back into physical therapy, and how fast we want the patient to get back into sports activities.
The length of pain relief after a cortisone shot depends on the condition being treated, how long it has been present, and which part of the body is being injected. If a cortisone shot is working for the patient, it can last at least 3 to 6 months, and sometimes longer. If it doesn’t last that long, there might be other underlying issues present that might need other treatments, or even more advanced treatments, such as surgical procedures. But for the cases in which cortisone shots work, it should last for a 3- to 6-month period.
With the correct diagnosis, and if a cortisone shot is used for the right reasons, sometimes all a patient needs is one cortisone shot to get past the acute pain, and the longer-lasting pain relief will come from gradually increasing activity level and rehabilitating the injured area. Occasionally, a second cortisone shot can be effective to stop any recurrent pain issues as the injury is healing.
As mentioned earlier, sometimes a cortisone shot can cause an initial increase in pain for at most about 24 hours. This can occur if the body briefly increases its inflammatory response before drastically decreasing inflammation in response to the cortisone. It depends on the person and the affected body part. But if initial pain occurs after a cortisone shot, it usually doesn’t last for long.
The side effects for a cortisone shot are usually related to the steroid itself (the main ingredient) rather than other agents that may be in the injection. The potential side effects are the same as those from oral steroid medication. Serious side effects are rare, but common, minor side effects include insomnia or flushing in the face.
Steroids can cause insomnia, which is usually seen more often in patients around age 65 and older. Insomnia from a cortisone shot could last anywhere from 1 to 3 days. This can feel like a “hyper” sensation, almost like when someone has had too much caffeine. Another possible side effect is an increased feeling of “flushing” in the face for a few days, depending on the dose of steroid given. This doesn't happen to everybody, but it can happen from time to time.
In people with diabetes, cortisone will raise blood sugar, so there must be plans to manage this – especially among patients who use insulin. It’s not usually dangerous because this effect is usually for a relatively brief period, but if someone’s blood sugars are poorly managed and they're usually very high, the patient might have to wait to get a cortisone shot until their blood sugars are better controlled.
One rare but benign side effect of steroids is hiccups. We do have ways of treating this side effect, or alternatively, hiccups can be allowed to take their course over a very short period of time.
A rare and more serious consequence – especially if you receive too high a dose of steroids or have been taking a prolonged regimen of steroids – is that steroids can reduce bone density over time. This is something that should be discussed with your physician if you are receiving cortisone shots more than once or twice. Usually, this side effect might occur when people are getting cortisone injections on a monthly basis, or otherwise very frequently and for an ongoing period of time.
Another rare but very serious consequence of having either too high a dose or too many cortisone shots is adrenal gland suppression. This would also happen with oral steroids as well, so this is a very well-known fact that most doctors will counsel you on.
There are a few cases in which cortisone shots may have very optimal outcomes. Two cases that can often have optimal outcomes include bursitis – inflammation of a bursa (a closed, fluid-filled sac that acts as a cushion and gliding surface to reduce friction between tissues in the body) – or mild joint inflammation from a milder form of arthritis, or from a mild tendon or muscle injury.
Certain conditions of the spine can also have optimal outcomes from cortisone shots if the patient has significant pain, but they are also doing appropriate physical therapy and a home exercise program. For example, conditions such as a herniated disc: This condition may not be bad enough to require surgery, but it still creates a painful sensation that hinders basic activity and basic exercise. A cortisone shot in cases such as this can have a very optimal outcome when paired with physical therapy afterwards to prevent the patient from possibly having a surgical situation later on.
Cortisone shots would not be recommended for people with certain conditions, including a current infection, recent bone fracture, a near-future planned surgery or spinal conditions causing neuropathies. In general, we don't recommend cortisone shots when someone has had a recent fracture in any bone. Cortisone shots in that area could actually reduce healing of the fracture.
Before having surgery on a specific area of the body, we might recommend not having a cortisone injection within a three-month period before the surgery. Because cortisone reduces inflammation, it could negatively affect the outcomes of the surgery and wound healing, especially for a knee or hip replacement.
Another reason for not getting a cortisone shot is if you have a very serious injury in the spine that is causing very significant numbness or weakness. In this case, we might hold off on doing a cortisone injection because we don't want to mask those symptoms from getting worse, which might require a surgical solution to the problem.
Any time that something more serious is going on and we want to monitor it and make sure the symptoms are not getting worse, we may not want to do a cortisone injection, because while that would reduce your pain, it may hide other serious things happening in the body. That likely happens in cases in which we already have full diagnostic imaging that's involved in a full diagnosis indicating a serious problem that we want to monitor.
At HSS, we recommend having cortisone shots no more frequently than a time frame of 3 to 6 months, regardless of which part of the body the patient is receiving them.
Sometimes we can give the shots a little bit closer together if we think the situation calls for it, and if we don't think it's going to become a chronic problem and we just need to acutely treat the pain. In these situations, we might give a second cortisone shot four to six weeks after the first shot.
But in general, problems with cortisone shots can occur if you’re getting them for a longer period of time. We recommend getting them not more frequently than every 3 to 6 months, depending on the condition, and depending on what's going on with the patient during that time frame.
If you’re ready to get help for your painful injury or condition, book an appointment with one of our pain management physicians.