A cortisone shot, formally known as a corticosteroid injection, delivers a potent anti-inflammatory medication directly into a localized area of pain. This compound mimics the effects of cortisol, a hormone naturally produced by the adrenal glands, suppressing the body’s inflammatory response. When administered correctly, these injections can provide significant relief from swelling and pain associated with conditions like bursitis or tendonitis. Experiencing no relief after treatment is frustrating and prompts a necessary re-evaluation of the initial problem and the treatment execution.
When the Diagnosis Does Not Match
Corticosteroids work by targeting and reducing inflammation, a biological process characterized by swelling and pain caused by immune cell activity. The medication is highly effective when the source of pain is truly inflammatory, such as in cases of acute synovitis or reactive tendonitis. If the pain is primarily mechanical, the injection offers little benefit because there is no underlying inflammation for the steroid to suppress.
Purely mechanical issues, like a large meniscal tear or advanced, bone-on-bone osteoarthritis, involve structural damage that the anti-inflammatory drug cannot repair. Similarly, nerve compression syndromes, such as pain from a herniated disc (radiculopathy), do not respond well to local anti-inflammatory treatment alone. The pain signals are generated by pressure and irritation, not by the localized inflammation the shot is designed to address.
A failure of the shot often signals that the initial diagnosis may have incorrectly identified the primary source of the pain. For example, pain radiating down the leg might be attributed to hip bursitis when the true origin is a lower back nerve issue (sciatica). Injecting the hip bursa in this scenario misses the actual pathology causing the symptoms. This misidentification means the medication was delivered to the wrong anatomical structure, rendering the procedure ineffective for the patient’s problem.
Issues Related to Injection Technique
Even with a precise diagnosis, the injection’s success hinges on the accurate placement of the medication within the target area. The corticosteroid solution must bathe the inflamed tissue, whether it is a bursa, a joint capsule lining, or an irritated tendon sheath. If the needle tip is slightly off course, the drug may disperse into surrounding muscle or fat, diluting its concentration and preventing it from reaching the site of inflammation.
Many injections use a landmark-based technique, relying on the physician’s anatomical knowledge and palpation to guide the needle. This method has an inherent margin of error, particularly in deep or complex joints like the hip or shoulder. Utilizing image guidance, such as ultrasound or fluoroscopy, significantly increases accuracy, confirming that the medication has reached the intended pathological site. Studies show that unguided injections into certain joints can have accuracy rates as low as 40 to 60 percent, improving significantly with image confirmation.
A temporary increase in pain following the shot, often called a “cortisone flare,” can be misinterpreted as a treatment failure. This reaction occurs in a small percentage of patients, caused by localized irritation from the crystalline steroid formulation itself. This flare is usually short-lived, resolving within 24 to 48 hours as the crystals dissolve and the anti-inflammatory effect begins.
Severity of the Underlying Condition
Even when the injection is placed correctly and the diagnosis is accurate, the severity of the underlying condition may overwhelm the drug’s capacity. Cortisone acts as a temporary brake on the inflammatory process, but it is not a cure for chronic structural problems or advanced tissue degeneration. In cases of severe, long-standing tendinopathy, the degree of tissue damage may require more than a single dose to achieve lasting relief.
A common scenario involves patients with high-grade osteoarthritis, where significant cartilage loss has led to bone-on-bone contact. While cortisone can reduce joint lining inflammation (synovitis), the underlying mechanical destruction continues unabated. Relief is often minimal and short-lived, fading within days or a couple of weeks rather than lasting the expected several months, signaling the treatment’s limitation in advanced disease.
Systemic factors can influence the effectiveness and duration of the steroid’s action. Patients with poorly controlled diabetes, for example, may experience a diminished anti-inflammatory response due to altered metabolic and immune function. The body’s response to the steroid can vary significantly between individuals, with some patients metabolizing the drug faster than others. The half-life of injectable corticosteroids can range widely, impacting how long the effect persists.
The success of a cortisone shot is heavily dependent on post-procedure care, particularly resting the affected area. If the patient immediately returns to high-impact activities or heavy loading, the inflammatory cycle is quickly re-triggered. This immediate re-injury negates the therapeutic window the injection was meant to provide, wasting the medication by reintroducing the stimulus that caused the pain.
Discussing Alternative Treatment Paths
When a cortisone injection fails, the next step involves a comprehensive re-evaluation with the healthcare provider to confirm or refine the original diagnosis. This process often includes advanced imaging studies, such as magnetic resonance imaging (MRI) or computed tomography (CT) scans, to visualize soft tissues and bony structures. These images can reveal previously missed structural tears or nerve impingements that explain the lack of response to the steroid.
Based on the re-evaluation, the focus shifts to non-steroid interventions that target tissue repair or lubrication rather than inflammation. For joint issues, options may include viscosupplementation injections, which deliver hyaluronic acid to improve joint fluid quality and cushioning. For chronic tendon issues, therapies like Platelet-Rich Plasma (PRP) therapy, which uses the patient’s own growth factors, may be considered to stimulate healing.
Physical therapy remains a fundamental component of recovery, and a failed injection often necessitates a re-assessment of the rehabilitation program. The physical therapist may adjust exercises to focus on different muscle groups or biomechanical corrections. If all conservative measures—including injections, rest, and targeted rehabilitation—have failed, a consultation with a surgeon may become the final step to address significant structural damage.