Cortisone injections deliver corticosteroids, synthetic versions of hormones, directly to affected areas to manage pain and inflammation. While effective at reducing swelling and discomfort, they have potential negative aspects. Understanding these outcomes is important for anyone considering this treatment.
Immediate and Common Reactions
Immediately after a cortisone injection, common and generally mild reactions can occur. Temporary pain or soreness at the injection site, often called a “cortisone flare,” is frequent and may worsen before improving. This flare, caused by corticosteroid crystallization within the joint, typically resolves within one to two days. Bruising and redness around the injection area are also common and usually subside within a few days.
Temporary facial flushing, with warmth and redness in the face and chest, can occur. This non-allergic reaction typically resolves within 24 to 72 hours. For diabetics, a temporary increase in blood sugar levels is a recognized side effect, usually returning to baseline within a few days, but potentially lasting up to 5-7 days. Diabetic patients may need to monitor blood sugar more frequently for about five days after the injection.
Potential Systemic and Localized Complications
While less common than immediate reactions, cortisone injections can lead to more significant localized or systemic complications. Skin changes at the injection site, such as thinning, discoloration, or dimpling from fat atrophy, can occur due to the corticosteroid’s localized effect.
Infection at the injection site, though rare, is serious and requires immediate medical attention. Signs include increasing pain, redness, swelling, warmth, fever, chills, or pus. Allergic reactions, though uncommon, can range from mild skin rashes to severe responses like difficulty breathing.
Tendon weakening or rupture is another serious, rare complication, especially if injected directly into a tendon. Healthcare providers take precautions to avoid this. Nerve damage, manifesting as new or worsening numbness or weakness, is a very rare but serious complication.
Considerations for Repeated Injections
Multiple cortisone injections over time introduce additional risks due to cumulative effects. Frequent injections into the same joint can lead to cartilage degradation and damage, raising concerns about long-term joint health. Some studies suggest an association between repeated injections and cartilage loss.
Bone thinning (osteoporosis), especially in nearby bone, is a rare but serious risk with frequent or higher doses. Adrenal gland suppression, where the body’s natural corticosteroid production temporarily decreases, can also occur with repeated systemic absorption, though it is usually temporary. Healthcare providers generally limit injections to a specific area, typically no more than three or four times a year in a single joint, with at least 12 weeks between injections, and often no more than six total injections per year across all areas. This helps mitigate increased complication risks, including infection, from more frequent procedures.
When to Seek Medical Attention
Be aware of symptoms warranting immediate medical consultation after a cortisone injection. Signs of infection, such as severe or increasing pain, fever, chills, unusual redness, or pus at the injection site, require prompt evaluation. Contact a medical professional for signs of a significant allergic reaction, including difficulty breathing, widespread rash, or swelling of the face or throat.
New or worsening numbness or weakness, especially in the injected limb, should be reported without delay. Any other severe, unexpected, or persistent symptoms causing concern should be communicated to a healthcare provider. Prompt reporting ensures timely assessment and appropriate management.