A cortisone (corticosteroid) shot combines a synthetic steroid medication with a local anesthetic. The goal is to reduce localized inflammation and pain in areas like joints, tendon sheaths, or bursae. Due to its potent anti-inflammatory effects, it is frequently used for musculoskeletal issues, including arthritis, tendonitis, and bursitis. It offers a non-surgical way to manage symptoms and often helps a patient move forward with physical therapy and rehabilitation.
Determining if the Shot Truly Failed
Immediate pain relief is often due to the local anesthetic, which is temporary and wears off within a few hours. The actual anti-inflammatory action of the steroid takes longer to begin.
Most patients begin to feel the effects of the corticosteroid within three to seven days, though it can take up to two weeks to experience significant pain reduction. For this reason, a healthcare provider will generally wait for about seven to fourteen days before determining that the injection has failed to provide relief. A small number of patients may experience a temporary increase in pain, known as a “cortisone flare,” for a day or two before the medication starts to work.
Primary Reasons for Lack of Efficacy
If the pain persists beyond the expected two-week window, there are several medical and mechanical reasons why the treatment may not have worked.
One possibility is imprecise needle placement, failing to deliver the medication to the exact source of inflammation. While the anesthetic confirms the general painful area, the steroid must be deposited where inflammation is most active. Imaging guidance, such as ultrasound or fluoroscopy, can improve accuracy.
Another reason for failure is that the underlying issue is not primarily driven by inflammation. The pain might stem from advanced structural damage, such as severe osteoarthritis or a complete tear, which a steroid cannot repair. The damage may be too extensive for the anti-inflammatory effect to overcome the mechanical source of pain.
The pain may also be neurogenic or referred, stemming from a pinched nerve or a problem elsewhere. Cortisone reduces inflammation but cannot fix biomechanical issues or nerve compression. Finally, individual patient metabolism plays a role, as responses to corticosteroids vary significantly.
Diagnostic Review After Failed Treatment
When a cortisone injection fails to provide relief, the next step involves a comprehensive review of the original diagnosis. The healthcare provider will perform a thorough physical re-examination to reassess the symptoms, including the range of motion, strength, and specific points of tenderness. The goal is to confirm if the initial target was correct or if a misdiagnosis occurred.
Advanced imaging is often ordered at this stage to look for structural problems that may have been missed or underestimated. A magnetic resonance imaging (MRI) scan can provide detailed images of soft tissues, such as tendons, ligaments, and cartilage, to identify tears or severe degeneration. An ultrasound may be used to visualize the specific area in motion or confirm the location of fluid collections or tendon pathology.
This re-evaluation helps rule out conditions that mimic inflammatory pain but require different treatments. By correlating physical exam findings with detailed imaging, the provider determines if the pain is due to a mechanical issue, nerve involvement, or degeneration. This process ensures the next treatment targets the true root cause of the discomfort.
Next Steps and Alternative Treatment Paths
Following a diagnostic review that confirms the cortisone shot was ineffective, a shift in treatment strategy is warranted. Physical therapy (PT) is often the most recommended next step, as it addresses the underlying biomechanical or movement issues that may be causing the problem. PT focuses on strengthening surrounding muscles, improving joint stability, and restoring normal movement patterns to alleviate stress on the painful structure.
For certain conditions, especially osteoarthritis, alternative injection therapies may be considered. Hyaluronic acid injections can improve lubrication and shock absorption within a joint, offering a different mechanism of relief than the steroid. Another option is Platelet-Rich Plasma (PRP) therapy, which uses a concentration of the patient’s own blood platelets to deliver growth factors that stimulate tissue repair and healing.
If pain is persistent and severe, a short course of oral non-steroidal anti-inflammatory drugs (NSAIDs) may be prescribed while a long-term plan is developed. If advanced imaging reveals significant structural damage, such as a large tear or severe joint destruction, consultation with an orthopedic surgeon is necessary. Surgical intervention, like joint replacement or tendon repair, provides definitive treatment for problems unmanaged by conservative methods.