Frequently Asked Questions
This article aims to answer the most common questions that people ask about cortisone injections. Cortisone is a commonly used treatment which can be helpful in the management of a wide variety of musculoskeletal problems when used appropriately.
Every injection will be different for each person and so your clinician should always discuss individual expectations with you. However, the following information gives a general overview of cortisone injections.
What is Cortisone?
Cortisone (a type of corticosteroid) is a member of the glucocorticoid family of steroids. It is found naturally in the body, being produced in small quantities by the adrenal glands. It has been used as a drug since the 1940’s to treat inflammation, a discovery which earned the researchers a Nobel Prize for medicine.
Who can provide a cortisone injection?
Cortisone injections can be provided by a wide range of different healthcare professionals provided that they have been appropriately trained. Doctors, Physiotherapists, Podiatrists and Specialist Nurses are among the common clinicians who can administer cortisone injections for MSK problems in the UK.
What do Cortisone injections do?
Cortisone injections help reduce pain and inflammation in joints and also various soft tissues, such as muscles, tendons, ligaments and around nerves. The two most commonly used corticosteroid drugs in the UK are Depo-Medrone (methyprednisilone acetate) and Kenalog (triamcinolone acetonide).
Will it hurt?
This depends on the type of injection but usually a Cortisone injection feels similar to when you give blood. However, the injection can be sore for a few hours afterwards so it is common to use cortisone mixed with a local anaesthetic to help with this.
Where does the needle go?
For a joint injection the needle is placed into the space between the bones. The needle does not go into the bone. For soft tissue injections the needle is placed into the problem area, usually a tendon, ligament or part of a muscle.
How is the needle put in the right place?
Delivering cortisone injections is a skilled technique requiring many hours of training. The clinician will carefully feel around the area in order the find the right needle entry point. We call these 'land-marked injections' as the clinician uses various bony prominences to help them identify the right area.
Over recent years 'Image guided injections' are becoming more widely used. The clinician used Ultrasound or X-Rays to guide the needle directly into the target area. This has obvious advantages, particularly for small joint injections or for deeper structures.
How quickly will it work?
Cortisone has a slow release effect. It usually takes a few days before it starts to work. Because of this, it is usual that the area can feel a bit more painful for a day or two.
What should I do afterwards?
Again, this depends of the type of injection but the usual advice is to rest the injected area from strenuous activity for a few days. You would not normally need to take any time off work unless you have a particularly heavy manual job. If the injection site is painful for a day or 2 (see side effects below) then you can take your regular pain-killers if required.
How long will it last?
Cortisone is usually effective in the tissues for up to 6 weeks. Over this time it is acting to reduce inflammation. Whether the pain and inflammation return after the injection has worn off depends on the condition being treated. Sometimes a single injection of cortisone will cure the problem.
Degenerative conditions such as Osteoarthritis tend to have variable results. Injecting a ‘flare-up’ of arthritic pain and swelling in a joint may help settle the condition back to its usual background level. Injecting an arthritic joint which has been slowly worsening over many years is likely to provide temporary pain relief, although this can sometimes be for many months. For arthritis, an alternative to cortisone are Hyaluronic Acid injections which are thought to provide a longer period of pain relief (6-12 months) for mild to moderately osteoarthritic joints.
Can Cortisone injections be repeated?
There is no hard and fast rule regarding how many cortisone injections a person can have. However, Cortisone does have side effects (see below) and repeated injections should be done with caution. In most cases clinicians will impose a limit of three injections into one area per year. The frequency of repeated injection varies depending on the individual diagnosis and personal circumstances. Joint injections for osteoarthritis can be repeated at 4 monthly intervals but if their effect is lasting for less than the 4 months it might be worth trying a Hyaluronic Acid injection, or speaking to your doctor about other possible treatments (eg. joint replacement surgery).
Is Cortisone Harmful?
Steroids taken in tablet form are associated with numerous side effects, as the treatment is often taken for long periods of time and the cumulative dosage can be high. Cortisone injections use much lower dosages and are often used as a one-off treatment. As such, the common side effects associated with long term steroid use (eg. weight gain, osteoporosis) are not a problem with cortisone injections.
Is Cortisone the same type of steroid that body builders use?
No. Body builders use anabolic steroids which are synthetic drugs related to testosterone. They are used to build muscle bulk and have many unpleasant side effects when used over time.
Are there any side effects of Cortisone?
Cortisone injections are widely used to treat musculoskeletal pain and inflammation and are considered to be a very safe form of treatment. However, as with any drug, there are a number of possible side effects, most of which are minor and uncommon. The main side effects are listed below.
- You may experience a flare up of pain after a cortisone injection. This can last for up to 48 hours until the effect of the cortisone starts to work. Local anaesthetics are often mixed with the cortisone in order to help reduce this.
- Bruising can occasionally occur after any injection. This would normally clear up within a week or 2.
- You may notice a feeling of warmth in your face for a few days (facial flushing). This is not usually a severe or uncomfortable symptom.
- When injections are given near to the surface of the skin, you may notice a small area of whiteness (depigmentation), or a dip in the skin (lipoatrophy) around the needle site. This is because cortisone has the potential to reduce skin pigmentation and dissolve fatty tissue. This is an uncommon side effect but has been noted following tennis elbow, hip region and some wrist injections. Sometimes the pigment and skin contour return over a year or 2 but it can occasionally be permanent feature.
- Irregular menstrual bleeding has been noted by some female patients for up to a week following a cortisone injection. Post-menopausal vaginal bleeding has also been known to occur in some patients for a few days, although this is a rare complaint.
- Diabetics may experience a temporary increase in blood sugar levels for up to 7 days.
- Infection is perhaps the most serious potential complication following an injection. There is an infection risk with any injection (giving blood, having a flu jab etc.) but thankfully due to the use of sterile & disposable equipment, the risk of infection is extremely low. Infection risks are raised if you are being treated for an infection elsewhere or if you are taking drugs which may reduce the immune response (immuno-suppressants). Your clinician will take your full medical history and discuss any potentially increased risk factors with you in detail. The risk of infection is reported as being between one in 17,000 – 77,000n patients.
- Anaphylaxis is an extremely rare form of allergic reaction to the injected drugs. This is an emergency situation which would require hospital admission. There are no reliable figures for anaphylaxis risk but it is thought to be an extremely rare event.
This article provides general information related to various medical conditions and their treatment. It is intended for informational purposes only and not a substitute for professional advice, diagnosis or treatment provided by a doctor or other qualified health care professional. The information provided does not constitute personal advice or guarantee of outcome and should not be used to diagnose yourself or others. You should never ignore advice provided by a health care professional because of something you have seen or read on this website. You should always consult a doctor or other qualified health care professional for personal medical advice.