A cortisone shot is a corticosteroid injection that delivers a powerful anti-inflammatory medication directly into a painful area to reduce swelling and ease discomfort. These injections often combine the steroid with a local anesthetic and are an effective treatment for musculoskeletal issues like tendinitis and bursitis. They work by mimicking the effects of cortisol, a naturally produced hormone, to quickly suppress the localized inflammatory response.
The Scope of Primary Care Injections
The direct answer to whether a primary care physician (PCP) can administer a cortisone shot is often yes, depending on their specific training and comfort level. Many PCPs are authorized to perform these procedures for common, easily accessible musculoskeletal conditions encountered in the office setting. These injections are frequently performed to relieve pain and improve function when patients have not responded to initial conservative therapies.
PCPs commonly handle injections into superficial joints and soft tissues where needle placement relies on anatomical landmarks. Examples include injections into the knee joint for osteoarthritis, the shoulder’s subacromial bursa for impingement, or the heel for plantar fasciitis. They also frequently treat conditions like carpal tunnel syndrome, trigger finger, and various forms of tendinitis, such as tennis elbow.
A PCP’s ability to perform these injections is determined by the procedural training received during residency and continuing medical education. Policies and regulations regarding who can perform these procedures can vary by state and the specific healthcare system.
When a Specialist Referral is Necessary
While PCPs manage many common cortisone injections, a referral to a specialist is necessary in certain instances. These situations involve anatomical locations that are harder to reach or cases requiring specialized imaging for precise needle placement. Injections into deeper joints, such as the hip joint or the sacroiliac joint, often fall outside the typical primary care scope.
Complex and Image-Guided Procedures
Specialists are required for most spinal injections, including epidural steroid injections or facet joint injections, which treat pain originating from the spine. These procedures carry greater risk and demand meticulous technique, often relying on fluoroscopy or ultrasound guidance. This guidance ensures the medication is delivered accurately without damaging nerves or other structures. Orthopedic surgeons, rheumatologists, and pain management specialists typically perform these complex, image-guided procedures.
A referral is also warranted when the underlying diagnosis is complex or uncertain, or when previous non-guided injections have failed. For example, a hip injection is often referred due to the need for imaging guidance to accurately target the joint capsule.
What to Expect During the Procedure
Receiving a cortisone shot is typically a quick, in-office procedure. The medical provider will first clean the injection site thoroughly with an antiseptic solution to minimize the risk of infection. A local anesthetic, such as lidocaine, is often mixed with the corticosteroid or applied separately to numb the skin and reduce discomfort.
The injection itself may feel like a sensation of pressure or a brief stinging as the fluid is delivered into the targeted area. After the injection, the provider applies a small bandage, and the patient is usually monitored briefly. Patients are advised to protect the area for one to two days, avoiding heavy lifting or strenuous activity on the injected limb.
Potential Side Effects
A temporary side effect known as a “cortisone flare” may occur in the first 24 to 48 hours. During this time, pain, swelling, and irritation briefly worsen before the steroid begins to take effect. This temporary increase in discomfort can often be managed with rest and ice. Individuals with diabetes should be aware that the steroid can temporarily elevate blood sugar levels, requiring more frequent monitoring.