A cortisone shot, or corticosteroid injection, is a localized anti-inflammatory treatment used to quickly reduce swelling and pain in an affected joint or soft tissue. When this injection fails to provide meaningful or lasting relief, frustration is understandable. The lack of response suggests the underlying cause of the pain was not adequately addressed by suppressing inflammation. A failed injection necessitates a methodical search for alternative solutions that promote long-term function and structural health.
Re-evaluating the Initial Diagnosis
The first step after a failed cortisone injection is a thorough reassessment of the original diagnosis. The lack of response may indicate the wrong problem was being treated, as cortisone offers little benefit if inflammation is not the primary driver of pain. For example, the pain source may have been misidentified, such as mistaking chronic nerve irritation for simple joint inflammation.
Another possibility is that the underlying issue is structural, such as advanced joint degeneration or a significant tendon tear, which a steroid cannot repair. The initial injection itself may also have been a procedural failure, where the medication missed the specific target area. This often occurs when the injection is performed without imaging guidance like ultrasound or fluoroscopy. A medical professional will often order follow-up imaging or perform a more detailed physical examination to confirm the true cause and severity of the pain.
Non-Invasive Conservative Treatments
Once the diagnosis is confirmed or refined, the next course of action focuses on non-invasive conservative measures. These treatments address the mechanical and muscular causes of pain. Physical Therapy (PT) and Occupational Therapy (OT) are foundational, aiming to correct underlying biomechanical issues that contribute to tissue overload, such as strengthening weakened muscles and restoring proper movement patterns.
Targeted pharmacological management can be used alongside therapy to manage symptoms without systemic steroid exposure. This may include oral non-steroidal anti-inflammatory drugs (NSAIDs) or medications designed to calm irritated nerve pathways if nerve involvement is suspected. Using assistive devices also provides immediate relief by offloading the painful area, allowing for a better environment for healing. Examples include custom orthotics, specialized bracing, or supportive splints to limit stress on the affected joint or tendon.
Advanced Injection and Procedural Options
When conservative measures are insufficient, the next phase involves more advanced, minimally invasive procedures. These procedures offer a different mechanism of action than simple inflammation suppression. One category is regenerative medicine, which includes Platelet-Rich Plasma (PRP) therapy. PRP involves isolating and concentrating platelets from the patient’s own blood and injecting them into the injured area to deliver growth factors, promoting tissue repair and healing.
Viscosupplementation
For joints affected by osteoarthritis, viscosupplementation, or hyaluronic acid injections, can be considered. These injections aim to restore some of the natural lubricating and shock-absorbing properties of the joint fluid degraded by arthritis. They provide mechanical support to the joint, a function cortisone does not offer.
Radiofrequency Ablation (RFA)
A third option for chronic pain, especially when nerve involvement is significant, is radiofrequency ablation (RFA). This procedure uses heat generated by radio waves to create a lesion on the specific nerve transmitting the pain signal. RFA effectively interrupts the signal to the brain for an extended period and is often considered when diagnostic nerve blocks confirm the nerve is the primary source of discomfort.
When Surgery Becomes Necessary
Surgical consultation is typically reserved as the final option after comprehensive non-operative treatments have failed to restore function or provide acceptable pain relief. The decision to proceed is usually triggered by persistent, debilitating pain that interferes with the quality of life. It is also necessary for definitive structural problems that cannot be fixed otherwise, such as complete tendon or ligament tears, severe joint instability, or end-stage arthritis.
If multiple cortisone injections have failed (typically three to four within a year), it signals that the underlying pathology is too advanced for non-surgical intervention. The goal of surgery is to achieve definitive structural correction, such as joint replacement, fracture fixation, or tendon repair. Medical providers often recommend waiting a period of months after a final cortisone injection before undergoing joint replacement surgery due to a small increase in the risk of post-operative infection.