A cortisone shot, or corticosteroid injection, delivers potent anti-inflammatory medication directly into a painful area. These synthetic steroids mimic cortisol, suppressing the local immune response and reducing swelling. This often leads to significant pain relief in joints, tendons, or bursae affected by conditions like arthritis or tendinitis. While these injections are frequently effective, experiencing minimal or no relief is not uncommon and requires a thorough reevaluation of the underlying problem.
Understanding the Lack of Relief
When a cortisone injection fails, it suggests the initial treatment did not address the primary source of pain. A frequent reason for failure is an inaccurate diagnosis, where pain is mistakenly attributed to inflammation when a structural or mechanical issue is the real culprit. Corticosteroids calm inflammation, but they cannot resolve pain caused by mechanical impingement, nerve entrapment, or severe tears in ligaments or menisci. For example, advanced osteoarthritis causes pain primarily from bone-on-bone friction, which anti-inflammatory medicine cannot remedy.
The technical placement of the medication also plays a significant role in the injection’s success. If the corticosteroid solution does not reach the exact site of pathology, such as a specific tendon sheath or joint capsule, its effectiveness is drastically reduced. While image guidance like ultrasound or fluoroscopy minimizes this risk, injections performed without visualization have a higher chance of missing the intended target. Additionally, the severity of the condition may simply overwhelm the localized dose of medication.
A single injection may not be powerful enough to overcome widespread or chronic inflammation present for an extended period. For some individuals, a systemic issue, such as an undiagnosed autoimmune disorder like rheumatoid arthritis, requires broader treatment beyond a single localized injection. In these cases, the pain is not isolated to the injected area but is a manifestation of an ongoing body-wide process. A lack of response to the injection provides important diagnostic information for the healthcare provider.
Medical Reassessment and Follow-Up
Following a failed cortisone injection, the healthcare provider begins a systematic medical reassessment to understand the reason for the lack of response. This process starts with a detailed physical re-examination and an updated patient history to check for any new or evolving symptoms since the injection. The goal is to confirm the exact pain location and rule out a “cortisone flare,” which is a temporary increase in pain that occurs for a day or two after the procedure.
The next step frequently involves advanced diagnostic imaging to better visualize musculoskeletal structures. While standard X-rays provide information on bone structure, a Magnetic Resonance Imaging (MRI) scan offers detailed pictures of soft tissues, including cartilage, tendons, and ligaments. This can reveal underlying structural damage, such as a significant tear or a herniated disc, missed during the initial evaluation. Advanced ultrasound may also be used to dynamically visualize the joint and surrounding tissues.
The physician must rule out a rare but serious complication, which is joint infection, known as septic arthritis. Although uncommon, an infection should be considered if the patient experiences worsening pain, significant warmth, or fever shortly after the injection. If the diagnosis is confirmed and the initial failure is attributed to technical reasons or insufficient dosing, a second injection may be considered. However, due to the potential for local tissue damage, physicians generally limit injections to approximately three per year in a single joint, often waiting at least three months between doses.
Exploring Non-Injection Treatment Options
When a cortisone injection provides no relief, the focus shifts to therapeutic interventions that address the root cause of the pain rather than just inflammation. Physical therapy (PT) is often the first and most effective next step. PT focuses on strengthening surrounding muscles, improving joint mechanics, and correcting faulty movement patterns. A PT program aims to stabilize the area, increase flexibility, and reduce the mechanical stress contributing to the ongoing pain.
For conditions like osteoarthritis, alternative injections may be considered. Viscosupplementation uses hyaluronic acid, a substance that naturally occurs in joint fluid, injected to provide lubrication and shock absorption. This offers relief distinct from the anti-inflammatory action of cortisone. Platelet-Rich Plasma (PRP) therapy is another option, involving injecting a concentration of the patient’s own growth factors to promote tissue healing and regeneration.
In terms of pharmacology, the physician may prescribe a course of oral anti-inflammatory drugs or specific medications designed to target nerve-related pain. These systemic treatments offer a different mechanism of action than the localized injection. When non-invasive or minimally invasive treatments fail to resolve symptoms caused by severe structural issues, such as a large rotator cuff tear or advanced joint degeneration, a consultation with an orthopedic surgeon becomes the next step to discuss surgical repair or joint replacement options.