While cortisone injections can be an effective treatment for joint inflammation and pain, they are not without limitations. Many of these limitations are discussed further below.
A cortisol injection is part of a larger treatment strategy.
These injections provide only short-term relief. Patients looking for long-term relief are usually advised to:
Take part in physical therapy. Stretching and strengthening muscles and other soft tissues can help alleviate pain and other symptoms of arthritis. One study1 found that physical therapy provided better long-term relief than cortisone injection therapy.
Get rid of excess weight. Losing weight can help to reduce joint stress. Another reason to lose weight is that cortisone injections may be less effective in relieving knee osteoarthritis pain in obese patients. 2
Change your way of life. Simple changes, such as changing footwear, can reduce the number of micro-traumas experienced by a joint daily.
These steps can help to improve the biomechanics of a joint and potentially reduce or eliminate the need for additional cortisone shots.
The joint pain will most likely worsen over time if no other treatments are used.
Patients who receive cortisone shots regularly may notice that the period of pain relief becomes shorter and shorter over time. This is not necessarily due to the patient’s tolerance to the medication but rather to the joint degrading. Again, physical therapy, weight loss, and daily lifestyle changes can help slow or stop joint degeneration.
Activity should be gradually increased.
It may take a few days for the cortisol medication to full effect. Patients are usually advised to rest and limit their everyday activities.
Once the joint pain has subsided, a well-intentioned patient may be tempted to begin an exercise regimen right away. However, to avoid injuries or worsen the condition, a doctor will typically advise a patient to resume normal activities and gradually increase the intensity.
Soft Tissue Can Be Affected by Repeated Injections
Excessive injections in a short period can harm the tendons, ligaments, and articular cartilage at the injection site.
3 Because of this:
If multiple injections are required in the same joint, they should be spaced several weeks apart.
4 Many doctors would rather wait for a more extended time—at least 3 to 4 months. 5 It is recommended that patients have no more than three or four injections in the exact location per year. 4
Before operating on the affected joint, a surgeon will typically require a 3-month waiting period following a cortisone injection.
Tendons are especially vulnerable to degeneration and injury following a cortisone injection. Because of this risk, a doctor will not inject cortisone directly into a tendon, even if a tendon is suspected of being the source of the pain. Because cortisone has a local effect, an injection near a tendon can reduce inflammation.
Even if an injection is directed near, rather than in, the tendon, the Achilles and patella tendons are particularly vulnerable to injury post-injection. As a result, cortisone injections for Achilles and patella tendinopathies are avoided by doctors.
Procedure for Cortisone Injection
A cortisone injection given in a doctor’s office can help relieve inflammatory joint pain. The procedure is divided into several steps and usually takes less than 5 minutes, and it may be mildly to moderately painful.
Ultrasound or other imaging technology may be used during the procedure. The following factors determine the use of imaging technology:
Preference of the doctor
Anatomy of the patient
Injection of a joint
All joint injections should be performed using imaging technology. All spinal and sacroiliac injections must use imaging technology to avoid injury to vertebral discs or nerve roots and ensure that the targeted joint is injected.
Because the cortisone injected is frequently mixed with a local anesthetic, the injected area may feel numb immediately after the procedure. The drug usually wears off within a few hours, at which point the patient may experience increased joint pain. This pain usually goes away within 24 hours, but it can last up to three days.
Step-by-Step Cortisone Injection
A typical cortisone injection procedure is described in detail below. Depending on the condition being treated, an injection may be used to deliver medication directly into the joint capsule or near the joint capsule.
The patient will be asked to sit or lie down in a position that allows the doctor easy access to the affected joint. For example, if a knee injection is given, the patient may be instructed to lie on their back with the knee straight or bent at a 20° or 30° angle, supported by a rolled-up towel.
A disinfectant, such as alcohol or iodine, will be used to clean the injection site.
Relaxation will be encouraged for the patient. Relaxing the muscles around the joint will make the injection process more accessible and more comfortable.
If ultrasound is used, a gel will be applied to a small area of skin near the injection site, and a hand-held ultrasound transducer will be gently pressed against the gel-covered skin by a technician. The doctor will see an image of the joint space projected on a screen.
The doctor may use a topical anesthetic to numb the area receiving the injection.
If the affected joint or bursa has an excess fluid, the doctor may use a needle and syringe to drain it. This is referred to as
A small amount of cortisone will be injected into the affected area by the doctor. Cortisol can be combined with an anesthetic, such as lidocaine or bupivacaine. The patient may feel a pinching or burning sensation, and the needle has been removed.
The injection site has been cleaned and bandaged.
To help spread the cortisone, the patient may be asked to flex and straighten the joint several times.