A cortisone shot, or corticosteroid injection (CSI), delivers powerful anti-inflammatory medication directly to a localized area of pain, such as a joint, tendon sheath, or bursa. Corticosteroids are synthetic versions of the hormone cortisol, designed to suppress the body’s inflammatory response, reducing swelling and discomfort. While often effective, sometimes the injection fails to produce adequate or lasting results. When initial injection therapy does not succeed, medical professionals re-evaluate the condition and explore alternative treatments.
Diagnostic Reassessment
After a cortisone shot fails, the first step is a thorough diagnostic reassessment. A lack of response suggests the initial diagnosis may have been incomplete, or the underlying issue is more complex. Failure can indicate that inflammation was not the primary source of the pain, or that the medication did not reach the intended target area.
This re-evaluation often involves reviewing original diagnostic imaging and potentially ordering more advanced scans. Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) scans provide detailed images, helping to confirm structural damage like tendon tears or nerve compression. Injection failure might also point to a problem with the technique, especially if imaging guidance like ultrasound or fluoroscopy was not used for precise needle placement.
The possibility of referred pain must also be considered, where the source of discomfort is located elsewhere in the body, such as spinal issues causing leg or shoulder pain. Confirming the anatomical structure responsible for the symptoms allows the medical team to accurately select the next therapeutic intervention. This detailed review ensures that subsequent treatments address the root cause of the pain.
Conservative Treatment Modalities
After confirming the diagnosis, the focus shifts to maximizing conservative, non-invasive treatments that improve biomechanics. Physical Therapy (PT) or Occupational Therapy (OT) is a cornerstone of this phase, addressing mechanical issues that injections cannot fix. A therapist designs a targeted exercise regimen aimed at strengthening supporting muscles, stabilizing the area, and reducing mechanical stress.
These therapeutic exercises improve flexibility, range of motion, and posture, addressing the underlying cause of irritation. Manual therapy techniques, such as joint mobilization and soft tissue manipulation, are often incorporated to reduce pain and promote tissue healing. Strengthening the surrounding musculature provides a long-term solution and durability against recurrence, unlike temporary corticosteroid relief.
Pharmacological management is also optimized, involving adjusting oral medications like nonsteroidal anti-inflammatory drugs (NSAIDs) or using muscle relaxers. Conservative care includes lifestyle adjustments, such as activity modification, utilizing supportive devices like braces or orthotics, and weight management to reduce joint load. These treatments are prioritized because they carry minimal risk while actively resolving the mechanical issues causing discomfort.
Alternative Interventional Procedures
If conservative measures are insufficient, the next step involves exploring specialized, minimally invasive procedures. These interventional procedures serve as a bridge between foundational conservative care and more invasive surgical options.
Platelet-Rich Plasma (PRP) therapy is one option, involving drawing the patient’s blood, concentrating the platelets, and injecting the solution into the injured area. The concentrated platelets stimulate a biological healing response, encouraging the repair of damaged tissues. This approach promotes tissue regeneration, differing fundamentally from corticosteroids which only suppress inflammation.
Another procedure is a nerve block, which involves injecting a local anesthetic and sometimes a small dose of steroid near a specific nerve to interrupt pain signals. For chronic pain, especially related to the spine or persistent joint pain, Radiofrequency Ablation (RFA) may be considered. RFA uses heat to create a lesion on a nerve, disrupting the transmission of pain signals to the brain, providing longer-lasting relief than a temporary nerve block. Hyaluronic acid injections, or viscosupplementation, can also be used to lubricate joints, typically reserved for knee osteoarthritis.
Evaluating Surgical Intervention
Surgical intervention is the final step, reserved for cases where pain is severe, non-operative methods have failed, and functional capacity is significantly limited. The decision requires consultation with a specialist, such as an orthopedic surgeon or neurosurgeon. This consultation confirms the underlying structural damage driving the persistent pain.
Surgery is considered when imaging confirms a problem that cannot be corrected otherwise, such as a large rotator cuff tear, severe spinal cord compression, or advanced joint destruction. The goal of the surgical evaluation is to determine if an operation can provide a definitive solution and restore meaningful daily function. The specialist weighs the potential benefits against the risks, reviewing the patient’s history and diagnostic evidence.
Patients play an active role by considering the recovery time, potential complications, and realistic outcomes. The surgical decision is highly individualized and pursued when pain is unmanageable with conservative or interventional care. Options range from minimally invasive arthroscopy to complex joint replacement or spinal fusion, aimed at repairing or removing the source of chronic pain.