When a Cortisone Shot Does Not Provide Relief
A cortisone shot is a common medical procedure intended to reduce inflammation and relieve pain in a targeted area, such as a joint or tendon sheath. The injection typically contains a corticosteroid, a potent anti-inflammatory medication, combined with a local anesthetic for immediate comfort. While often effective for conditions like bursitis, tendonitis, or arthritis flares, the treatment is not universally successful, and a lack of relief is a recognized possibility. When a cortisone shot fails to provide the expected improvement, it prompts a necessary re-evaluation of the initial diagnosis and the treatment strategy.
Defining Non-Response: What to Expect and When to Worry
A cortisone shot is a combination of two agents: an immediate-acting local anesthetic and a slower-acting corticosteroid. The initial relief felt within minutes is due to the anesthetic, which wears off within hours. The true anti-inflammatory effect of the steroid takes time to develop, typically providing sustained relief within two to seven days.
A “non-response” is generally defined as experiencing no significant improvement in symptoms after seven to ten days following the procedure. A temporary increase in pain, known as a “cortisone flare,” can occur for one to two days as the injected material crystallizes, but this is usually followed by improvement. Success is not guaranteed, especially in cases of chronic or advanced disease where inflammation may not be the sole cause of pain.
Factors Limiting the Shot’s Effectiveness
One of the most common reasons a cortisone shot might not work relates to the technical aspect of the procedure itself. The medication must be delivered precisely to the inflamed tissue, whether that is a joint space, bursa, or tendon sheath. If the injection misses the intended target, the corticosteroid will not reach the site of inflammation in sufficient concentration to be effective.
The use of imaging guidance, such as ultrasound or fluoroscopy, can significantly increase the accuracy of placement, especially in smaller joints or deeper structures. In some cases, the targeted inflammation may be too severe or chronic for a standard dose to overcome, leading to a marginal or short-lived response. Furthermore, dense scar tissue or fibrotic changes can sometimes prevent the injected medication from adequately dispersing throughout the inflamed area.
When Lack of Relief Suggests a Deeper Issue
The failure of a cortisone shot often suggests that the initial diagnosis was incomplete or that the pain source is not primarily inflammatory. Corticosteroids are designed to suppress inflammation, but they do not address mechanical or structural problems within the joint or surrounding tissues. If the patient’s pain is rooted in instability, degeneration, or tissue damage, the anti-inflammatory drug will have little effect on the underlying cause.
Conditions like severe tendon tears, ligament ruptures, or advanced osteoarthritis frequently present with pain that mimics inflammation. In late-stage arthritis, the pain is often caused by bone-on-bone friction and mechanical stress rather than active inflammation, which cortisone cannot resolve. Similarly, nerve entrapment or impingement is a structural problem that is unresponsive to an anti-inflammatory injection.
The lack of response serves as a diagnostic signal, indicating that the pain is likely mechanical, structural, or neurological. This outcome often necessitates further diagnostic steps, such as magnetic resonance imaging (MRI) or ultrasound, to visualize soft tissue damage or nerve compression.
Alternative Approaches After Injection Failure
When a cortisone shot fails to provide sufficient relief, the next step involves a re-evaluation of the treatment plan. A physician may consider advanced imaging, like an MRI, to confirm or refine the diagnosis. If the original injection was performed without guidance, a second injection using ultrasound or fluoroscopy to ensure precise placement may be considered, though physicians are cautious about repeated steroid use.
Physical therapy is frequently the next course of action, focusing on addressing any mechanical issues, muscle imbalances, or poor movement patterns contributing to the pain. Other non-corticosteroid injection options may also be explored, such as hyaluronic acid injections for joint lubrication, or regenerative medicine techniques like Platelet-Rich Plasma (PRP) therapy. For cases where significant structural damage is confirmed and conservative treatments have all failed, a consultation with a surgical specialist becomes necessary.