What is a “cortisone injection”?
A cortisone injection, or corticosteroid injection, is a catch all term for an injection of a body part, using a derivative of a steroid/glucocorticoid and often a local anesthetic. Injecting a glucocorticoid and local anesthetic into an area of pain can be very effective in relieving the pain. In some instances it can also prevent the pain from recurring.
What types of conditions can be treated with a cortisone injection?
Frequently, the injection is into a painful or damaged joint. Common joints that are injected include the knee, shoulder, hip, ankle and small joints in the hands and feet. Soft tissue areas can also be injected for pain relief of common issues such as tennis elbow, golfer’s elbow, rotator cuff impingement, trigger fingers, trochanteric bursitis and many more.
What is the injection actually doing?
When you injure a part of your body it can cause tissue damage. This triggers an immune response in your body to try and heal the damaged tissue. Blood flow is increased to that area, delivering many different kinds of blood products and cells to aid in restoring the tissue. This is a good thing at first. But then it causes swelling and increased pain in the area. In a way, the pain is considered good as it reminds the patient to protect the area of injury; however, no one likes pain. Also, all that swelling in the area can actually inhibit the healing process. This is where the corticosteroid injection comes in to play. The steroid is effective in reducing pain because it decreases inflammation at the injection site. It works at the molecular level by making proteins that inhibit the inflammation cascade, ultimately decreasing inflammation at the injection site. Cortisone is actually a natural occurring substance in our bodies and we just use a large dose at a specific area hoping for faster and more dramatic results. Cortisone injections are usually performed in combination with other therapies. For some patients this may include physical therapy and/or an anti-inflammatory regimen.
What about aspirating the joint before doing the injection?
Aspiration of the joint is done to remove excess fluid from the joint. This is often used to relieve pressure and pain in the joint if it is very swollen. This procedure can be done by itself or prior to an injection. Doing this can help to make sure the steroid does not get diluted in all of the joint fluid. Aspiration is usually only utilized for moderate to severe effusions. It is not always performed prior to an injection. Aspiration of the joint can also be used as a diagnostic tool. The fluid can be sent to the lab to help diagnose the cause of the joint swelling. This information allows for potential treatment of the underlying problem, instead of just relieving the symptoms.
Is a cortisone injection right for me?
This is something that only your group of healthcare providers can decide for you. Here are some general reasons cortisone injections may be a bad option for you: infection, blood sepsis, rash over injection site, allergy to the medication used, history of a total joint, fracture, multiple injections in the past without any relief. Here are some general conditions where cortisone injections may be a good option for you: arthritis, tendinitis, bursitis, ganglion cysts, neuromas, gout, and synovitis.
What if I have diabetes? Can I still get an injection?
Administering steroids can affect blood glucose levels. So, there is always concern for how steroids will affect someone with diabetes. Fortunately, cortisone injections have very little, if any, effect on the blood glucose levels. To be safe, we tell patients to monitor their glucose levels a little closer for a few days following the injection.
How fast will it work and how long will it last?
How fast the injection works and the length of relief the injection provides varies from patient to patient. Some patients notice immediate relief from the injection, but it can take up to a few weeks to notice relief. The steroid itself can take up to 3 weeks to work. As far as how long it will last, some patients may get a year of pain relief but some patients may only get a few days of relief. Unfortunately, there is no way to tell how much relief each individual patient will get from an injection.
How often can I get cortisone injections?
This can vary from physician to physician. Usually, patients can get a cortisone injection about every 3 months if they are providing significant relief. Getting them too close together can actually cause damage to the joint or tissues.
Will there be any restrictions after?
Often patients are recommended to take it easy for 24-48 hours following the injection. If you work a sedentary job, you can usually return to work the same day.
Are there any side effects?
Some patients may notice an increase in pain for a day or two following the injection. This is usually self-limiting and can be treated with NSAIDS, ice and elevation. Additionally, any time a needle is inserted into the body, there is a small chance for infection. Sterile precautions are taken during the injection to reduce this risk. It is also possible to have an allergic reaction to the medications used, but this is rare.
How do I get an injection?
Any of our physicians at Three Rivers Orthopedic Associates would be happy to evaluate you to see if an injection is the next step to help relieve your pain. Call 412-782-3990 to make your appointment with one of our physicians today!
By Bethany Wink PA-C