Cortisone shots, or corticosteroid injections, are a common medical procedure designed to provide localized, temporary relief from pain and inflammation. These injections contain a powerful anti-inflammatory medication, a synthetic version of the hormone cortisol, which suppresses the body’s inflammatory response at the injection site. Physicians frequently use them to treat conditions like tendonitis, bursitis, and various forms of arthritis in joints, tendons, and soft tissues. The goal is to reduce swelling and discomfort, often allowing the patient to participate more effectively in physical rehabilitation.
Reasons Why Cortisone Shots May Lack Efficacy
A frequent reason an injection fails is an incorrect initial diagnosis, where the true source of pain is misidentified. Cortisone targets inflammation, but pain can originate from non-inflammatory sources, such as referred nerve pain or mechanical instability. For instance, a localized tendon issue might actually be pain radiating from a spinal problem, which the corticosteroid cannot address.
Technical precision is another significant issue, particularly if the injection is performed without imaging guidance. For the medication to work, it must be deposited directly into the inflamed area, such as a specific joint space or bursa. If the needle misses the precise target, the corticosteroid will not reach the tissue generating the inflammation and pain.
The underlying pathology may be too advanced for a cortisone shot to make a difference. In severe degenerative arthritis, where cartilage loss is extensive, the pain is structural rather than purely inflammatory. Chronic tendon issues, often classified as tendinosis, involve degeneration and a lack of inflammatory cells, meaning the anti-inflammatory properties are ineffective against the structural tissue damage.
Understanding the Typical Duration of Relief
When assessing failure, it is important to distinguish between no relief and short-lived relief, and to understand the medication’s timeline. Immediate pain relief is primarily due to the local anesthetic mixed with the corticosteroid. This anesthetic effect wears off quickly, typically within a few hours, which is a normal part of the process.
The true anti-inflammatory effect of the corticosteroid takes time to manifest, often requiring several days, or up to a week, to reach its full potential. Patients are advised to wait this period before concluding the injection was ineffective. Relief can last anywhere from a few weeks to several months, depending on the condition and the individual’s response.
A return of pain after a few weeks, rather than a total lack of initial relief, often indicates the shot worked, but the underlying problem is persistent. Since the corticosteroid does not cure the condition, pain symptoms will reappear once the drug is metabolized. If symptoms return rapidly (within two to four weeks), it suggests continued disease progression or a significant mechanical issue that the temporary anti-inflammatory action could not overcome.
Diagnostic Review and Immediate Clinical Steps
When a cortisone shot fails, a medical professional initiates a comprehensive diagnostic review to re-evaluate the original problem. This often involves obtaining new imaging, such as an MRI, ultrasound, or specialized X-rays, to confirm or adjust the initial diagnosis. Imaging helps determine if there is a more advanced structural issue, such as a larger tear or severe joint degeneration, that was not fully appreciated.
If the diagnosis is confirmed but the injection failed, the physician may consider whether the technical application was flawed, especially if the procedure lacked imaging guidance. A repeat injection may be discussed, but only if the first provided partial relief or if technical error is suspected. Due to concerns about potential damage to cartilage and tendons, medical guidelines typically limit injections to no more than three or four shots per year in a single location.
A failed injection prompts a re-evaluation of the patient’s physical therapy protocol, as the injection is intended to aid rehabilitation, not serve as a standalone cure. The physical therapist may need to modify or intensify strength and mobility exercises to address underlying biomechanical problems contributing to the pain. If conservative treatments remain unsuccessful, the physician may recommend a referral to a specialist, such as an orthopedic surgeon or a rheumatologist, for advanced assessment.
Non-Corticosteroid Treatment Options
If a cortisone shot proves ineffective, several alternative non-surgical and surgical options are available. For patients with osteoarthritis, an alternative injection is viscosupplementation, which involves injecting a gel-like substance containing hyaluronic acid into the joint. This substance improves the joint’s lubrication and cushioning, helping to ease pain and improve mobility.
Injections promoting tissue repair, such as Platelet-Rich Plasma (PRP) therapy, are used when the underlying issue is degenerative or non-inflammatory. PRP involves concentrating a patient’s own platelets and injecting them into the affected area to stimulate natural healing. For some conditions, nerve blocks or radiofrequency ablation may be used to interrupt pain signals, providing longer relief by targeting the nervous system.
When conservative and minimally invasive procedures fail, surgical intervention may be the final consideration. This could range from minimally invasive procedures like arthroscopy to major procedures such as joint replacement or reconstructive surgery. These options are reserved for cases where structural damage is the primary cause of pain and function loss.