Cortisone shots, also known as steroid injections, are a common medical treatment used to address pain and reduce inflammation in specific areas of the body. These injections contain corticosteroids, which are manufactured drugs that mimic cortisol, a hormone naturally produced by the adrenal glands. Cortisone works by temporarily reducing the immune system’s activity in the targeted location, thereby decreasing inflammation and alleviating associated pain. They are frequently used for conditions such as arthritis, tendonitis, and bursitis, aiming to provide localized relief.
Common Side Effects
Following a cortisone injection, some individuals may experience a temporary increase in pain and inflammation, often referred to as a “cortisone flare.” This flare typically occurs within 24 to 48 hours after the shot and usually subsides on its own within a few days. Alongside this temporary discomfort, minor bruising, redness, or warmth at the injection site are also common.
Localized skin changes can also manifest, such as thinning of the skin or discoloration, appearing as a lightening or whitening of the skin around the injection area. For individuals with diabetes, a temporary increase in blood sugar levels is a recognized side effect that can last for several days after the injection. These common side effects are generally mild and resolve without specific intervention.
Serious Risks and Long-Term Concerns
While generally safe, cortisone shots carry more serious, though less common, risks, especially with repeated use. There is a rare risk of infection at the injection site, which can lead to conditions like septic arthritis. Tendons, particularly in areas like the Achilles or patellar tendon, can weaken with frequent injections, increasing the possibility of rupture.
Damage to joint cartilage is another concern, particularly with multiple injections into weight-bearing joints. Some studies suggest repeated injections may accelerate cartilage loss. While local injections typically do not cause systemic bone weakening, frequent or high-dose systemic corticosteroid exposure can contribute to bone density loss.
Localized loss of subcutaneous fat, known as fat atrophy, can result in a visible indentation or dimple at the injection site. There is a possibility of nerve injury if the needle inadvertently strikes a nerve during the injection. Frequent or high-dose injections may temporarily suppress the body’s natural production of corticosteroids, potentially leading to adrenal insufficiency.
When to Exercise Caution
Certain medical conditions necessitate careful consideration before receiving a cortisone shot. Individuals with diabetes should be aware that cortisone injections can cause temporary blood sugar spikes, requiring close monitoring and potential adjustment of medication. Avoid injections in areas with active infection to prevent spread.
Patients taking blood thinners or those with bleeding disorders face an increased risk of bruising or bleeding at the injection site. Those with pre-existing osteoporosis should discuss the risks, as repeated systemic exposure could potentially exacerbate the condition. Individuals with glaucoma should also consult their doctor due to potential temporary increase in intraocular pressure. Pregnant or breastfeeding individuals should discuss benefits versus risks with their healthcare provider. Some medical professionals recommend avoiding injections immediately following certain vaccinations.
Minimizing Risks and Alternative Treatments
Healthcare providers often limit cortisone injections to 3-4 per year per joint, with at least three months between doses, to reduce tissue damage risk. Imaging guidance (e.g., ultrasound or fluoroscopy) can help ensure precise placement and effectiveness. After injection, rest the affected area and avoid strenuous activities for 24-48 hours. Applying ice can help manage any post-injection soreness.
Communicate your full medical history and medications to your doctor for the safest treatment plan. Alternative treatments to cortisone shots include:
Physical therapy, focusing on strengthening and flexibility, and activity modification.
Over-the-counter pain relievers (e.g., NSAIDs), and the application of ice or heat.
Bracing or splinting for support, and lifestyle adjustments like weight management and regular exercise.
Other injection therapies, such as hyaluronic acid or platelet-rich plasma (PRP).