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Cortisone Injection

By

Sarah Lewis, PharmD

What is a cortisone injection?

A cortisone injection is a treatment for a variety of diseases, disorders and conditions. Cortisone is a corticosteroid. Corticosteroids have potent anti-inflammatory effects. They can also help regulate your immune system’s activity. 

There are a many types of cortisones injections. Cortisone injection is often a generic term for injection of any of these corticosteroids. The goal of a cortisone injection is to regulate the immune system or reduce inflammation. Reducing inflammation helps relieve pain.

A cortisone injection is only one type of treatment. Discuss all your treatment options with your doctor or healthcare provider to understand which options are right for you.  

Types of cortisone injections

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The types of cortisone injections include:

  • Local injections reduce inflammation in a limited or small area of your body. Examples of local injections include intra-articular (joint) injections and epidural (spinal) injections.

  • Systemic injections reduce inflammation in your entire body or system or regulate your immune system’s activity. Systemic injections treat allergic reactions and some diseases that affect more than one area. Examples include rheumatoid arthritis, breathing problems, collagen diseases, and cancer.

Other procedures that may be performed

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Doctors can use cortisone injections by themselves to treat certain diseases, disorders or conditions. Cortisone injections are also used with additional treatments. Other treatments vary depending on the specific disease, disorder or condition. Talk with your doctor or healthcare provider about all the treatment options for your condition.

Why is a cortisone injection used? 

Your doctor may recommend a cortisone injection to treat a variety of diseases, disorders and conditions. These include:

  • Adrenal insufficiency or decreased functioning of your adrenal gland

  • Allergic reactions

  • Cancer

  • Collagen and autoimmune disorders, such as systemic lupus erythematosus

  • Joint problems, such as arthritis, bursitis and tendonitis

  • Respiratory problems, such as acute asthma attacks

  • Skin conditions, such as keloids and psoriasis

  • Soft tissue conditions, such as fasciitis and ganglion cysts 

  • Spine conditions, such as spinal stenosis or herniated disks

Who performs cortisone injections?

A cortisone injection is a fairly common medical treatment. Just about any type of doctor or healthcare provider trained in the procedure can give one as part of a routine office visit. Typically, the specialist who gives the injection will be the same one you visited for your specific condition. 

For example, if you need a cortisone injection as part of a treatment for joint pain from a sports injury, then the shot will likely be given by an orthopedic surgeon or sports medicine specialist. 

The following specialists give cortisone injections:

  • Allergists-immunologists are internal medicine doctors or pediatricians who specialize in the diagnosis, treatment and management of allergies, asthma and immunologic disorders.

  • Dermatologists specialize in treating conditions that affect the skin, hair and nails.

  • Endocrinologists are internal medicine doctors or pediatricians who specialize in the treatment of endocrine disorders.

  • Oncologists are internal medicine doctors or pediatricians who specialize in treating cancer.

  • Orthopedic surgeons specialize in the surgical treatment of diseases of the bones and connective tissues.

  • Physical medicine and rehabilitation doctors specialize in the prevention, diagnosis, and nonsurgical treatment and management of physical and mental disabilities

  • Sports medicine doctors specialize in the prevention, diagnosis, and nonsurgical treatment of exercise- and sports-related injuries.

How is a cortisone injection given?

Cortisone injections are given in various ways. These include:

  • Epidural injections, in which your doctor injects a corticosteroid near your spinal canal to reduce inflammation in the spine. Reducing inflammation can provide pain relief from spinal conditions, such as spinal stenosis, herniated disks, and injuries to your spinal nerves. This is a form of local injection. Your doctor will most likely combine a corticosteroid with a local anesthetic for epidural injections.

  • Intra-articular injections, in which your doctor injects a corticosteroid directly into your joint. This is also a form of local injection. Most of these injections take place in your doctor’s office or an outpatient setting. In cases involving joints that are difficult to access, such as the hip, your injection may take place in a hospital setting using imaging technology to guide the process. Your doctor may combine a corticosteroid with a local anesthetic for intra-articular injections.

  • Intralesional injections, which go directly into a skin lesion, such as acne or a keloid. A keloid is an overgrowth of collagen tissue at the site of a scar or wound. Your doctor may combine a corticosteroid with a local anesthetic for intralesional injections. Intralesional injections are a form of local injection.

  • Intramuscular injections, in which your doctor injects a corticosteroid directly into a muscle. Intramuscular injections are a form of systemic injection. These injections reduce inflammation in more than one area of your body. Your doctor may combine a corticosteroid with a local anesthetic for an intramuscular injection.

  • Intravenous injections, which go directly into your vein. They are a form of systemic injection. Intravenous cortisone injections are typically given as treatment for serious conditions in a hospital.

Your doctor will advise you on which type of cortisone injection is best for you based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different cortisone injections and ask why your doctor will use a particular type for you. 

Will I feel pain with a cortisone injection?

Your comfort and relaxation is important to both you and your care team. You may feel a brief pinch or prick during the needle insertion. Take a few long, deep breaths to help yourself relax. Tell your doctor or provider if any discomfort does not pass quickly. 

Types of anesthesia that may be used

Your doctor will likely use a local anesthetic before performing an epidural, intra-articular, or intralesional injection. The local anesthetic numbs your skin before the actual cortisone injection. Your doctor may combine the corticosteroid with more local anesthetic for the injection. You will be awake, but kept as comfortable as possible during the procedure.

What are the risks and potential complications of a cortisone injection?  

A cortisone injection involves risk and potential complications. Complications may become serious in some cases. Complications can develop during the procedure or your recovery. 

Risks and potential complications of a cortisone injection include:

  • Adrenal suppression or problems with your adrenal gland

  • Bleeding or bruising

  • Cartilage or nerve damage

  • Increased blood sugar

  • Infection

  • Injection site reactions including swelling, tenderness and warmth

  • Menstrual changes

  • Post-injection steroid flare, which is pain from a reaction to the crystallized structure of the steroid

  • Skin discoloration and skin or fat atrophy (abnormal shrinkage)

  • Sleep problems

  • Spinal headache with epidural injections

  • Weakened tendons, ligaments, bones and cartilage with repeated intra-articular injections

Reducing your risk of complications

You can reduce the risk of some complications by following your treatment plan and: 

  • Following activity, dietary and lifestyle restrictions and recommendations

  • Keeping all scheduled appointments

  • Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain

  • Informing your doctor if you are nursing or if there is any possibility that you may be pregnant

  • Taking your medications exactly as directed

  • Telling all members of your care team if you have any allergies

How do I prepare for my cortisone injection?

You are an important member of your own healthcare team. The steps you take before your cortisone injection can improve your comfort and outcome. 

You can prepare for a cortisone injection by:

  • Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications and allergies at all times.

  • Following any restrictions or recommendations about eating or drinking just prior to your procedure or treatment as directed 

  • Getting any necessary testing as directed. Testing will vary depending on your age, health and diagnosis. Testing may include X-rays or other imaging tests, EKG (electrocardiogram), blood tests, and other tests as needed.

  • Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.

Questions to ask your doctor

Preparing for a cortisone injection can be stressful. It is common for patients to forget some of their questions during a brief doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before a cortisone injection and between appointments.

It is also a good idea to bring a list of questions to your appointments. Questions can include:

  • Why do I need a cortisone injection? Are there any other options for treating my condition?

  • How long will the procedure take? When can I go home?

  • What restrictions will I have after the procedure? When can I return to work and other activities?

  • How often will I need cortisone injections? 

  • How will you treat my pain?

  • What kind of assistance will I need at home? Will I need a ride home?

  • How should I take my regular medications?

  • When will I receive the results of any tests?

  • When should I follow up with you?

  • How should I contact you? Ask for numbers to call during and after regular hours.

What can I expect after my cortisone injection?

Knowing what to expect after a cortisone injection can help you get back to your everyday life as soon as possible.

How will I feel after the treatment?

Pain is often reduced or relieved following a cortisone injection. There may be mild, temporary tenderness at the injection site after the procedure. You will also feel a little drowsy if you had sedative or pain medications.  

Follow your doctor’s instructions for rest and the use of ice packs after a cortisone injection. Your doctor may give you pain medication to control pain.

When can I go home?

Patients often go home right after a cortisone injection. If you had any sedative medications, you will go home when the major effects of sedation have worn off and you are fully alert, breathing effectively, and your vital signs are stable. You may need a ride home from your procedure. You may also need help at home for the first 24 hours.

When should I call my doctor?

It is important to keep your follow-up appointments after a cortisone injection. Contact your doctor for questions and concerns between appointments. Call your doctor right away if you have:

  • Bleeding

  • Difficulty breathing

  • Dizziness or fainting

  • Drainage from the injection site

  • Fever (you should not have any fever after a minor procedure)

  • New or unexplained symptoms

  • Pain that is not controlled by your pain medication

  • Rash or skin irritation

  • Severe or persistent headache or back pain

  • Skin changes

  • Swelling, warmth or redness

Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Sep 9, 2016

© 2017 Healthgrades Operating Company, Inc. All rights reserved. May not be reproduced or reprinted without permission from Healthgrades Operating Company, Inc. Use of this information is governed by the Healthgrades User Agreement.

View Sources

Medical References

  1. Cardone DA, Tallia AF. Joint and Soft Tissue Injection. Am Fam Physician. 2002;66(2):283-289. http://www.aafp.org/afp/2002/0715/p283.html
  2. Epidural Injections. American College of Radiology. http://www.radiologyinfo.org/en/info.cfm?pg=epidural
  3. Epidural Steroid Injections. North American Spine Society. http://www.knowyourback.org/Pages/Treatments/InjectionTreatments/ES_Injections.aspx
  4. Lavelle W, Lavelle ED, Lavelle L. Intra-articular Injections. Anesthesiology Clin. 2007;25:853–862. http://www.med.nyu.edu/pmr/residency/resources/injections%20and%20procedures/clinics%20anes_intra-ar...
  5. Robles DT, Moore E, Draznin M, Berg D. Keloids: pathophysiology and management. Dermatol Online J. 2007;13(3):9. Review. http://dermatology.cdlib.org/133/reviews/keloid/robles.html
  6. Spinal Injections. American Academy of Orthopedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=A00560
  7. Steroid Injections. Cleveland Clinic. http://my.clevelandclinic.org/services/steroid_injections/hic_steroid_injections.aspx

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