Cortisone or Corticosteroid Injections

Cortisone or Corticosteroid Injections

What is it?

Cortisone is a hormone released by the body in response to stress. The adrenal gland produces this hormone as a natural anti-inflammatory. Synthetically produced cortisone mimics the natural hormone produced by the body however is stronger and longer lasting than the natural form. Cortisone injections can be used to provide short-term relief for inflamed areas in the body. They are not pain relievers, and only work to relieve pain when inflammation is the cause of pain. Cortisone can be taken orally, inhaled, applied to the skin or injected.

What conditions can cortisone injections be used for?

Corticosteroids can be used to treat areas with local inflammation (local injections) or widespread inflammation (systemic injections into large muscles or intravenously). Conditions that may require local injections can include bursitis, tendinitis and joint pathologies such as osteoarthritis. Conditions that may require systemic injections can include allergic reactions, asthma, and rheumatoid arthritis.

A list of common conditions that corticosteroids can be for include:

  • Tennis elbow
  • Golfers elbow
  • Bursitis of the hip, knee or shoulder
  • Frozen shoulder
  • Plantar fasciitis
  • Carpal tunnel syndrome
  • Herniated disc
  • Rotator cuff injury

 

Pros and cons:

Pros:

– Reduce inflammation
– Rapid onset of relief
– Easy to administer
– Substance is well-tolerated by most patients

Cons:

Short-term complications:

  • Infection
  • Local bleeding
  • Nerve damage
  • Soreness at the injection site
  • Reaction to the corticosteroid medication
  • Tendon weakening or rupture
  • Temporary increase in blood sugar
  • Fascial flushing
  • Uncommon side effects can include sweating, dizziness, nerve damage and insomnia

 

Long-term complications: depend on the dose and frequency of injections:

  • Thinning of skin
  • Easy bruising
  • Weight gain
  • Acne
  • Blood pressure elevation
  • Cataract formation
  • Osteoporosis
  • Osteonecrosis (death of nearby bone)
  • Reduced effect after the first injection

Results:

The outcome generally depends on what condition the cortisone injection is being used for. However, the typical response is an increase in pain and inflammation for about 48 hours. After this, pain and inflammation should decrease which can last from a couple of weeks to several months. Since cortisone injections generally only provide temporary relief with possible complications, most patients are advised to participate in physiotherapy to stretch and strengthen joints, muscles, and other soft tissues. Your physiotherapist may also offer advice regarding other lifestyle factors such as weight loss, biomechanics, footwear/orthotics, and activity modification. Addressing these other factors that may contribute to pain can eliminate the need for a cortisone injection.

Evidence:

Studies in patients with tennis elbow have found that patients receiving cortisone injections improved better in the short term compared to patients receiving no treatment at all. However in the long term, the patients who received the cortisone injection had a much lower rate of full recovery at 6-12 months post-injury and a significantly higher rate of re-injury. This is because reducing inflammation/pain may mask the serious underlying injury. In addition, cortisone injections do not treat the problem and will not fix what caused the initial injury.

Cortisone injections may be used appropriately when conservative treatment has been trialled and inflammation has not settled after 6-12 weeks. In this case, a cortisone injection may help to relieve your symptoms so you can optimise your rehabilitation.

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