Cortisone / Corticosteroid Injection

What is cortisone?

Cortisone is the name given to a group of medications commonly known as corticosteroids. Corticosteroids are powerful anti-inflammatory agents that can be given via the oral and intravenous (IV) route or injected locally. They are used to treat a wide variety of musculoskeletal and non-musculoskeletal inflammatory conditions.

Why inject cortisone?

When given orally or IV, corticosteroids are absorbed into the bloodstream and act non-specifically throughout the entire body, causing numerous unwanted side effects.

Local injection of corticosteroid allows delivery of the medication in a high concentration directly to the desired location. Injected cortisone is generally well tolerated and causes minimal side effects.

What conditions can it treat?

Cortisone injection can be used to treat a wide variety of conditions, including:

  • Joint problems
  • Tendon problems
  • Bursitis
  • Nerve problems
  • Disc problems
  • Other conditions where inflammation is a contributor to pain

What are the common side effects?

  • Allergy – Some people may have allergies to any of the substances used in the procedure, including to cortisone, local anaesthetic, latex gloves, antiseptic solutions or adhesive bandages. This is usually minor and will improve without specific treatment.
  • Activation – Cortisone may cause facial flushing, increased alertness and difficulty sleeping in the first 24 hours post injection. This will resolve on its own and no treatment is required.
  • Skin changes – localised bruising and skin discolouration can occur, especially when cortisone is injected into a superficial structure.
  • Infection – Infection is a rare (1 in 10,000 chance) but potentially serious complication of cortisone injection. Most infections tend to come on 48 or more hours post injection. Signs may include redness and warmth over the injected area, increased pain and fevers or sweats. If these signs appear after the initial 48 hours post injection, urgent medical attention is required.
  • Tendon rupture – Cortisone injected into a tendon can weaken its fibres and increases the risk of delayed tendon rupture. Cortisone injection around a tendon using precision ultrasound guidance can reduce this risk.
  • In diabetics – cortisone injection can interfere with diabetic control for a few days to a week post injection. Vigilant diabetic care is recommended during this period.

How many cortisone injections can I have?

Whilst cortisone can rapidly reduce pain and restore function, it only hangs around in the affected area for about 6 weeks (depending on the type or cortisone used).

If the factors predisposing to injury have not yet been removed, pain may return. Whilst there is no definitively proven limit to the number of cortisone injection that can be performed, it is known that repeated cortisone can soften joint cartilage and weaken tendons.

It is therefore important to weigh up the risks of injection versus pain relief. Furthermore, if pain persists despite repeated injections, it is always a good idea to reassess whether the diagnosis is correct or whether different treatment is needed.

What should I do after a cortisone injection?

It is preferable to avoid any exercise using the injected area/limb for 48 hours post injection. This includes rehabilitation/strengthening exercises prescribed to treat the condition.

After 48 hours gentle strengthening may resume. Return to full training/play is dependant on the condition being treated. Ask Dr. Lewis for guidance.