Using Cortisone Shots for Inflammation

Cortisone shots are commonly used to treat joint-related problems like arthritis, tendonitis, and bursitis. Cortisone shots can provide long-term pain relief by decreasing inflammation in joint spaces and connective tissues.

Cortisone shots are generally safe, and side effects are rare. However, there are possible risks if you overuse cortisone, including long-lasting skin discoloration and ruptured tendons.

This article explains what cortisone shots are and the types of conditions they treat. It also looks at possible side effects and other injectable drugs you can use if cortisone is not right for you.

How Do Cortisone Shots Work?

Your body contains two small glands called adrenal glands that produce a hormone known as cortisol. Cortisol is released at times of stress and has many functions in the human body, including the suppression of inflammation. It is classified as a corticosteroid, meaning a steroid hormone produced by the adrenal glands.

Cortisone is the man-made version of cortisol. As a synthetic corticosteroid, it mimics the effects of cortisol and is used to treat a variety of inflammatory conditions.

Corticosteroids should not be confused with anabolic steroids that are used to build muscle.

What Conditions Can a Cortisone Shot Treat?

Cortisone shots are commonly used to treat inflammatory conditions affecting the joints or connective tissue. These include:

• Ankylosing spondylitis (an inflammatory disease of the spine)
• Autoimmune arthritis like rheumatoid arthritis and psoriatic arthritis
• Bursitis (inflammation of fluid-filled joint cushions called bursae)
• Carpal tunnel syndrome (caused by a pinched nerve in the wrist)
• Osteoarthritis ("wear-and-tear arthritis")
• Plantar fasciitis (inflammation of the thick band of tissue between the heel and toes)
• Spinal problems like spinal stenosis or herniated discs
• Tendonitis (inflammation of a tendon in the knee, elbow, or other joints)
  

Cortisone shots can also be used to treat inflammatory skin conditions like eczema (atopic dermatitis) or to reduce severe scars known as keloids. They are also sometimes given to prevent the development of nodules in people with sarcoidosis.

While osteoarthritis is generally non-inflammatory, the progressive deterioration of joint cartilage can trigger inflammation as bone rubs against bone and damages surrounding tissues.

How Cortisone Shots Are Given

Cortisone shots are given as intra-articular injections, meaning that the shots are given into a joint space. (There are exceptions, such as with plantar fasciitis in which the shot is delivered directly into connective tissues.)

The shot may involve the following steps, depending on the extent of joint inflammation:

1. The skin is cleaned with an alcohol swab.
2. A numbing injection or topical numbing agent may be used to reduce pain.
3. If the joint is filled with fluid, a larger needle may be inserted into the joint space to draw it out. This is known as arthrocentesis or joint aspiration.
4. After swabbing the skin again, a smaller needle is inserted into the joint space to deliver a dose of cortisone. For larger joints, several shots may be given at different places.
   

Cortisone shots in smaller joints may cause more pain than shots given in larger joints. Because of this, some healthcare providers will mix cortisone with an anesthetic such as lidocaine for immediate pain relief.

How Often Can You Get a Cortisone Shot?

There is no hard-and-fast rule as to how many cortisone shots you can get. Still, there are limitations and risk you need to consider.

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

Because of this, many healthcare providers limit the number of shots to no more than three per year at the same site. Even so, the decision to give more or fewer shots is made on a case-by-case basis, weighing the risks and benefits.

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

How Long Does a Cortisone Shot Last?

Cortisone shots usually work within 48 hours, and full relief is usually felt within a week.

The duration and level of pain relief can vary from one person to the next. Factors influencing the treatment response include age, the underlying condition, the joint being treated, and the severity of joint pain or injury.

With knee osteoarthritis, pain relief may last several months to up to a year for some people. But anywhere from 20% to 30% will have no treatment response, often because underlying joint damage is severe.

Side Effects

Cortisone injections are generally safe, but, like any drug, there are possible side effects and risks.

Possible side effects include:

• Injection site pain, sometimes lasting up to 48 hours
• Facial flushing, most often in people assigned female at birth
• Darkening of the skin around the injection site (usually when multiple shots are given)
• Hardening and dimpling of the skin (usually when multiple shots are given)
• A temporary increase in blood sugar
• Infection (rare but increasingly possible the more shots you get)

Cortisone Shot Alternatives

If you cannot tolerate a cortisone shot or the treatment stops working, there may be other options to consider.

Hyaluronic Acid

Hyaluronic acid is a natural fluid found in the joints that acts as a cushion and lubricant. Hyaluronic acid can also be manufactured in the lab and be used to supplement the fluid already in a joint space. It is given as an intra-articular injection, most often in the knee.

Hyaluronic acid doesn't reduce inflammation but may provide relief in people with significant joint damage from advanced knee osteoarthritis. The main side effect is injection site pain.

Platelet-Rich Plasma (PRP)

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

Injecting platelet-rich plasma (PRP) into an affected joint placed high concentrations of these growth factors into damaged joints. It is a less commonly used therapy but one may be beneficial to people with joint injuries and advanced osteoarthritis.

PRP is made with a supply of your own blood. The blood is placed in a centrifuge which separates the platelets and plasma from red and white blood cells. The PRP is then given by intra-articular injection. Because PRP comes from your own blood, side effects are rare.

Summary

Cortisone is a man-made corticosteroid that mimics the effects of cortisol. It is typically given by injection to reduce inflammation in joints or connective tissues. It is generally safe to use and can offer long-term relief from joint pain and swelling. Injection site pain is the most common side effect.

With long-term use, cortisone shots can cause the possible rupture of tendons. For this reason, most healthcare providers limit the number of shots to three per year for any single joint.