Using Cortisone Shots for Inflammation

Cortisone injections are used to treat orthopedic (bone and muscle) problems, such as arthritis, tendonitis, and bursitis. Cortisone isn't a painkiller. Rather, it reduces inflammation which, in turn, decreases pain.

Cortisone shots are very safe, and side effects tend to be rare and minor. However, there are a few things you should know before getting one.

This article explains what cortisone shots are and the types of pain they usually treat. It also takes a deeper look into the side effects of the shots, as well as some cases when caution may be needed.

How Cortisone Works

Your body makes steroid hormones naturally. Corticosteroids (like cortisol) are steroid hormones released by the adrenals, small glands that sit atop your kidneys. In addition to cortisol, your body makes other types of steroid hormones that help help your body function normally.

Cortisol is an important steroid that plays a role in reducing inflammation, maintaining blood sugar levels and blood pressure, and managing stress. It's also a part of your body's immune response.

Cortisone is the man-made version of cortisol, and it mimics its effects. As a corticosteroid medicine, it's used to treat a variety of conditions.

It's important to note that cortisone is different than anabolic steroids, which are used by some to build muscle.

Uses

Cortisone shots may be part of the treatment in cases where inflammation is an underlying problem. These conditions include, but are not limited to:

• Shoulder bursitis
• Arthritis
• Trigger finger
• Carpal tunnel syndrome
• Plantar fasciitis
• Tendonitis

Corticosteroids are also used to treat other conditions, including some skin conditions and rheumatoid arthritis.

Cortisone is a very powerful drug. By injecting into a targeted area of inflammation, strong doses of the steroid can be given while limiting possible side effects.

How Cortisone Shots Are Given

The procedure for giving a cortisone shot is similar to that of other injections:

1. The injection site is cleaned with an alcohol wipe.
2. Depending on your situation, a topical anesthetic may be applied to numb the skin.
3. If necessary, a needle may be used to remove excess fluid from the joint.
4. The shot is administered and the injection site is covered with a dressing.
   

Often, the cortisone injection can be done with a very small needle that causes little discomfort. Sometimes a slightly larger needle must be used, however, especially if your healthcare provider needs to remove fluid through the needle first.

Cortisone injections into small joints or tight spaces may cause more discomfort than shots given in larger joints. For this reason, injections into the shoulder or knee may be less painful than those given at the finger joints, feet, and tendons. A skilled provider usually can limit this pain.

Many healthcare providers mix cortisone with a pain reliever to offer both immediate and longer-lasting pain relief. Orthopedic surgeons, for example, often combine cortisone with a local anesthetic such as lidocaine or Marcaine (bupivacaine).

The added anesthetic has another benefit, too: If pain relief happens fast, it can mean that the cortisone is in the right spot.

How Often Can I Get Cortisone Shots?

There is no rule as to how many cortisone injections can be given. Still, there may be some practical problems with long-term use.

If a cortisone shot wears off quickly or does not help, then doing it again may not be worth it. Repeated cortisone injections also increase the risk of side effects.

That's why many healthcare providers limit the number of shots to usually no more than three in one year at the same site. But there are healthcare providers who use more cortisone than this, and still others who may recommend fewer shots.

Cortisone shots may not be recommended as a first-line treatment in younger people whose joints are still growing.

Talk with your healthcare provider about how often you can have an injection.

Side Effects

Cortisone injections are extremely safe. But like any drug, there are possible side effects and complications that can occur with a cortisone shot.

Some side effects impact the area of the injection site, while others are systemic, meaning they affect the whole body.

Local Side Effects

Local side effects are those that happen only in the one area of the body where the cortisone shot was given. These side effects are also rare, but you should know what to do if they happen to you.

Pain and ​Cortisone Flare Reaction

Some people have discomfort after the shot and may experience an increase in pain 24 to 48 hours after being treated. This usually goes away quickly and can be relieved with an ice pack and an anti-inflammatory medication like Motrin (ibuprofen).

Skin Color Changes

People with darker skin should know that cortisone may cause the skin around the injection site to lighten. This is not harmful.

Loss of Fatty Tissue

High doses of cortisone can harm some tissues in the body. One such problem a loss of fatty tissue, or fat atrophy, which can lead to dimpling of skin or the thinning out of fat. People who get shots in the heel to treat plantar fasciitis may find walking painful as the fat that cushions their steps may thin out.

Tendon Rupture

Some studies have shown cortisone shots may weaken tendons (the tough bands of tissue that connect muscles to bones) and cartilage (the tissue that covers and cushions bones). Tendon rupture is particularly a risk when cortisone is used for Achilles tendonitis.

Infection

Whenever there is a break in the skin—like when a needle is used to deliver cortisone—there is a chance of infection. Your healthcare provider will sterilize the skin to minimize this risk. If there is infection in the joint where you're receiving the shot, it could spread. Contact your healthcare provider if the injection site become red, swollen, or warm to the touch.

Systemic Side Effects

Cortisone shots aren't the same as oral steroids or cortisone that is injected directly into the bloodstream. Only a small amount of the drug is absorbed into the blood, which then travels through the body.

Since the body produces its own natural cortisol, this doesn't affect most people. That's not the case for everyone, however.

Systemic effects are not common. But when they do occur, high blood sugar and facial flushing are most common. Thankfully, they are usually minor.

High Blood Sugar

A cortisone shot can cause a temporary rise in blood sugar, so levels need to be closely monitored in people with diabetes. People taking insulin should be especially careful, checking their blood sugar often and adjusting their insulin doses as needed to maintain healthy levels.

If left untreated, high blood sugar increases your risk of stroke, heart disease, along with kidney, vision and nerve conditions. If your blood sugar rises more than expected, contact your healthcare provider right away.

Facial Flushing

Some people say they feel flushed and have redness in the face, though this happens more in women. Facial flushing can begin within a few hours of the injection and may last for a few days. It also can happen again with future cortisone shots.

Many healthcare providers are unaware of how common this reaction is and how upsetting it can be. The good news is that these symptoms do go away on their own, but it may make people think twice before having another shot.

Cortisone Shot Alternatives

If you cannot tolerate a cortisone shot, the treatment stops being effective for your condition, or you would rather not try it due to potential side effects, there may be other options to consider.

Two include hyaluronic acid (HA) injections and an experimental treatment where platelet-rich plasma (PRP) are injected into affected joints.

Hyaluronic Acid

Just as your body maintains natural levels of cortisol, it also produces HA.

One function of HA is to lubricate and cushion joints. However, sometimes aging—or conditions such as osteoarthritis—can cause levels to decrease. This can lead to stiffness, pain, or swelling in your joints.

HA Injections are given in the same fashion as cortisone shots, most often in the knee. Side effects are similar. One common one is a flare-up of arthritis symptoms, but this will fade.

The HA used for this treatment is grown in a laboratory from bacterial cultures.

Platelet-Rich Plasma (PRP)

Platelets and plasma are two key components of blood. In addition to helping blood clot, they also contain growth factors that play a role in the healing process.

Injecting platelet-rich plasma into an affected joint puts high concentrations of these growth factors in place to help the area heal.

This treatment is being studied for use to treat a variety of conditions where cortisone is also used, including joint injuries and osteoarthritis.

PRP is made using a sample of your own blood. The blood is placed into a centrifuge, which spins and helps to separate red and white blood cells from the platelets and plasma. Blood cells are removed, and the remaining plasma and platelets are concentrated. This is what is used in the injection, which is given just like a cortisone shot.

Because PRP uses your own blood cells, reactions are rare. More research is needed to better understand possible side effects, and conditions for which this treatment may be effective.

Summary

Cortisone shots are a powerful tool and a good treatment option for many conditions. But they may be overused or, in some cases, are not the best choice.

The shots should only be used to treat inflammation, not just injected for pain. Their use also should be limited, especially in younger people with healthy joints and tendons that may be damaged by repeated shots.

If you're experiencing pain in your joints, it's a good idea to look at all your options for managing pain and then talk them over with a trusted healthcare provider.