Corticosteroid injections, commonly known as cortisone shots, are a medical tool used to temporarily reduce localized pain and inflammation in the body. These injections deliver a synthetic version of the naturally occurring anti-inflammatory hormone cortisol directly to an affected area. Clinicians frequently use them to treat conditions like osteoarthritis, bursitis, tendinitis, and carpal tunnel syndrome. While often effective, patients sometimes find that the expected relief does not materialize, requiring them to explore other therapeutic options.
Understanding Treatment Expectations
A cortisone shot does not provide instant relief from the moment of injection, which is a common misconception that can lead to premature judgment of treatment failure. The shot typically includes a local anesthetic, which offers immediate but short-lived numbness that wears off within hours. The corticosteroid itself needs time to begin suppressing the inflammatory response at the cellular level.
The anti-inflammatory effects of the steroid generally start to become noticeable within three to seven days following the injection. Some patients may experience a temporary increase in pain, known as a cortisone flare, before the medication begins to work. True treatment failure is defined as experiencing no significant pain reduction after two to three weeks, or if the relief is extremely short-lived (lasting less than two weeks). If the injection only provides minimal or fleeting relief, it signals that the underlying issue has not been adequately addressed.
Primary Reasons for Lack of Efficacy
The most frequent reason a cortisone shot fails is that the primary source of pain was misidentified during the initial diagnosis. Cortisone is designed to treat inflammation, but if the discomfort is actually caused by mechanical issues, nerve compression, or advanced structural damage, simply reducing inflammation will not resolve the symptoms. For example, pain thought to be bursitis might actually be referred pain from a compressed nerve root in the spine.
Another factor is the precise placement of the medication, which can be challenging to achieve without technical assistance. If the cortisone does not reach the exact site of inflammation, its effectiveness is drastically reduced. Many practitioners now use image guidance, such as ultrasound or fluoroscopy, for improved accuracy. The structural severity of the condition can also overwhelm the medication’s effect, such as in advanced Grade 4 osteoarthritis where pain is driven by bone-on-bone friction rather than inflammation alone. Furthermore, if the localized inflammation is a symptom of a broader, systemic condition like an undiagnosed autoimmune disorder, a local injection will be insufficient to control the overall disease activity.
Alternative Treatment Pathways
When a cortisone injection provides no benefit, the first step is often a comprehensive re-evaluation using advanced diagnostic tools. An MRI or CT scan may be necessary to gain a clearer picture of the soft tissues, ligaments, and bone structure, which can reveal the extent of a tendon tear or a previously missed structural problem. This advanced imaging helps to confirm whether the issue is inflammatory, mechanical, or degenerative.
The next phase of treatment frequently involves non-steroid injectable alternatives aimed at tissue repair or joint lubrication.
Regenerative Injections
Platelet-Rich Plasma (PRP) therapy uses the patient’s own concentrated growth factors to stimulate healing and may be considered for conditions like chronic tendinopathy. For knee osteoarthritis, hyaluronic acid injections, also called viscosupplementation, can be used to restore some of the joint fluid’s natural lubricating properties. These treatments focus on promoting long-term change rather than temporary symptom management.
Physical Therapy and Surgery
Targeted physical or occupational therapy is a crucial step when a mechanical component is suspected, such as poor muscle activation or joint instability. A therapist can design a program to correct faulty movement patterns and strengthen supporting structures, addressing the root cause that the cortisone could not touch. When conservative measures, including a failed cortisone shot and regenerative injections, do not provide relief, the structural damage may be significant enough to warrant a surgical consultation. An orthopedic surgeon can evaluate the area for mechanical interventions, such as arthroscopic repair of a torn tendon or joint replacement for end-stage arthritis.