A cortisone shot involves injecting a corticosteroid, a powerful anti-inflammatory medication, directly into a target area of the body. The injection often includes a local anesthetic to provide immediate comfort alongside the steroid. The primary purpose is to rapidly reduce localized pain, swelling, and irritation. Cortisone shots treat conditions like arthritis, bursitis, and tendonitis, where inflammation causes discomfort.
Primary Medical Specialists Who Administer Injections
The type of doctor who administers a cortisone shot is determined by the anatomical location and the underlying medical condition. Orthopedic surgeons and sports medicine physicians frequently perform these injections for musculoskeletal issues. They commonly inject larger joints like the knee, shoulder, and hip, as well as injured tendons and ligaments. Their expertise focuses on mechanical joint problems and localized soft tissue injuries.
Rheumatologists routinely administer cortisone shots, particularly for patients suffering from inflammatory conditions such as rheumatoid or psoriatic arthritis. These specialists focus on systemic autoimmune diseases that cause widespread joint inflammation. They use injections to control inflammation in specific joints experiencing a painful flare-up.
For complex pain issues, especially those involving the spine or nerves, pain management specialists are often the providers of choice. This group includes anesthesiologists or physiatrists (physical medicine and rehabilitation specialists) who have completed fellowship training. They utilize injections, such as epidural steroid injections, to target inflammation around nerve roots causing radiating pain.
Primary care physicians (PCPs) may administer a cortisone shot for superficial and straightforward joint problems, such as a simple knee or shoulder injection. However, when the injection site is deep, involves complex anatomy, or requires specialized guidance, the patient is almost always referred to one of the aforementioned specialists.
The Role of Injection Guidance Technology
To ensure the medication reaches the precise target area, especially for deeper injections, doctors rely on imaging guidance technology. Precision is important because misplacement reduces the shot’s effectiveness and increases complication risks. The two most common forms of guidance are ultrasound and fluoroscopy.
Ultrasound guidance uses high-frequency sound waves to create real-time images of soft tissues, including tendons, muscles, and superficial joints. This technique is advantageous because it does not involve radiation exposure and allows the physician to continuously track the needle’s tip toward the target structure.
Fluoroscopy, which is a type of real-time X-ray imaging, is typically reserved for injections into deeper structures, such as the facet joints of the spine or the hip joint. It allows the doctor to visualize bony landmarks and often requires contrast dye to confirm the medication is flowing into the correct space. While it involves minimal radiation exposure, it is considered the most reliable method for accurately placing a needle in these deep, difficult-to-access areas.
Patient Preparation and the Injection Process
Receiving a cortisone shot begins with a consultation to review the patient’s medical history, symptoms, and medications. Patients taking blood thinners may need to temporarily stop them prior to the procedure to minimize the risk of bleeding or bruising. Any known allergies, especially to local anesthetics or contrast dyes, must be discussed with the provider.
During the procedure, the patient is positioned for optimal access, and the skin is cleansed with an antiseptic solution. A local anesthetic is often applied or injected first to numb the skin and underlying tissue, reducing the discomfort of the main injection. The actual injection is usually quick, lasting only a few minutes, though the patient may feel pressure or fullness as the medication is delivered.
After the injection, patients are advised to rest the affected joint for 24 to 48 hours and avoid strenuous activity. A temporary increase in pain, known as a “steroid flare,” is common and may last one to two days before the anti-inflammatory effect begins. Applying ice helps manage this short-term soreness. While the local anesthetic provides immediate relief, the full benefit of the cortisone is usually noticeable within two to seven days as inflammation subsides.
Understanding Risks and Frequency Limits
Cortisone injections are generally safe and effective, but patients should be aware of potential risks. Common, mild side effects include a temporary flushing sensation or a brief spike in blood sugar levels, which is a concern for diabetic patients. The temporary soreness or pain flare at the injection site is also a frequent, short-lived occurrence.
More serious, though rare, risks include infection, nerve damage, or an allergic reaction. For this reason, the procedure is performed under sterile conditions. A long-term concern involves the structural integrity of the injected tissue.
Repeated, frequent injections into the same location can potentially lead to damage, such as thinning of the cartilage within a joint or weakening of nearby tendons. To safeguard against these issues, medical guidelines recommend limiting cortisone shots to a maximum of three or four per joint annually. Furthermore, injections into the same joint should be spaced at least 12 weeks apart to allow tissue recovery and prevent cumulative damage.