About Corticosteroid Injections

For some patients who have been unsuccessful with other treatments for pain, corticosteroid injections may be a solution.

What are Corticosteroids?

Cortisone is a steroid hormone that is naturally released as a response to stress by the adrenal gland. Chemically, cortisone “is a corticosteroid closely related to cortisol”. Cortisone has medical uses, and it can be delivered transcutaneously, orally, into a joint, or intravenously. Its purpose is to reduce inflammation and pain at the injury site; however, it performs this action by suppressing the immune system. Cortisone injections may be used to treat pain and swelling from joint, tendon, or bursa inflammation. It is typically injected into the shoulder, elbow, and knee. Another use of cortisone is to purposely suppress the immune system so that rejection doesn’t occur from an organ donation. It may also be used for swollen and sore throats resulting from mononucleosis, to manage atopic dermatitis and eczema, and to treat keloids. There are many risks and side effects of using cortisone, especially if it is administered long-term.¹

Cortisone Shot Uses

Cortisone shots can relieve the inflammation and pain of joints throughout the body. Besides the elbow, knee, and shoulder, cortisone injections can target the ankle, hip, wrist, spine, and even the hands and feet. The shots include a local anesthetic and a corticosteroid medication. The shots a patient receives in a year are limited due to the risks of side effects. There are many conditions that cortisone shots can treat, including bursitis, carpal tunnel syndrome, gout, frozen shoulder, lupus, rheumatoid arthritis, tenosynovitis, osteoarthritis, plantar fasciitis, psoriatic arthritis, Morton’s neuroma, rotator cuff injury, tendinitis (tendonitis), and tennis elbow.² Kenalog and Celestone are a couple of the trade names for cortisone injections. The differences between synthetic and natural cortisone are that synthetic cortisone is injected into a particularly inflamed area, not the blood stream, and the synthetic version is meant to be more potent, lasting for days instead of just for minutes.³ The advantages of the corticosteroid injections are that they provide localized inflammation relief, so the pain and inflammation management is targeted and acts faster than oral medications. Stomach upset is also avoided with an injection, as compared to oral anti-inflammatory medications, and side effects are generally minimal.⁴

Risks

The cortisone shots carry potentially serious risks, though, including joint cartilage deterioration, nerve damage, joint infection, bone death, thinning skin, tendon rupture, and osteoporosis. This is why cortisone injections are not given more than 4 times a year, and they should not be provided to patients more frequently than every 6 weeks.⁵ Diabetics need to have caution with the shots, and blood sugar may transiently increase while using the cortisone. The most common side effect is called “cortisone flare”, which is a situation where the “cortisone crystallizes”, causing “a brief period of pain worse than before the shot”. After a couple of days of icing, this goes away. Another common problem with the shot is that the skin can whiten around the injection site. Infection, though rare, could be serious.⁶ Long-term complications, with higher frequency and doses may also include bruising, acne, weight gain, face puffiness, cataracts, and elevated blood pressure.⁷