What is Cortisone and What Should I Expect?

By Elizabeth Swift,  PT, DPT

Cortisone is a type of corticosteroid which reduces inflammation caused by a variety of diagnoses discussed below. Corticosteroids can be taken by the mouth (prednisone), given intravenously (solumedrol), or injected into the body (triamcinolone, kenalog, celestone, depomedrol). Corticosteroids are not pain relievers, but they reduce inflammation so if pain is reduced it is because inflammation was reduced. For the purpose of this blog, we will be discussing the corticosteroid injected into the body.

If you have developed…
● Bursitis
● Carpal tunnel syndrome
● Osteoarthritis
● Plantar fasciitis
● Rotator cuff injury
● Tendinitis
● Tennis elbow

…then a cortisone injection might be prescribed by your doctor. Your doctor might use the injection to make a diagnosis to rule conditions in or out, to provide rapid pain relief, and/or determine a treatment plan.

Benefits:
Cortisone injections can be easily administered at the doctor’s office. They provide rapid relief of localized inflammation and are more powerful than anti-inflammatory medications given by mouth. If given properly, cortisone injections are dependable and have minimal side effects. They are able to return function to a body or body part handicapped by inflammation. When used on conjunction with physical therapy, range of motion, stretching, and strengthening can be easier to accomplish.

Short-Term Side Effects
Although uncommon can include atrophy and discoloration of the skin around injection site, a bacterial infection if area is not cleaned properly, soreness at the injection site, or aggravation of the inflamed area due to reaction of medication (postinjection flare). If administered to patients with diabetes than temporary increased blood sugar in common.

Long-Term Side Effects
Depending on the dose and frequency of injections but can include easily bruising, thinning of skin, elevation of blood pressure, and degeneration of joint tissues. Repeated injections can cause deterioration of joint cartilage and weakening of the ligaments and tendons of the joint. For this reason, cortisone injections are typically limited to one every six weeks and no more than 3-4 times a year.

During Procedure
The area around the injection site should be cleaned. The doctor might provide a localized anesthetic to numb the area. Some injections will be guided by ultrasound or x-ray to determine the needle’s progress through the body to make sure the correct site is injected. You will most like feel pressure from the needle and the medication is injected into the inflamed site. Some injections will include an anesthetic to provide immediate pain relief.

After Injection
Your doctor may ask you to:
● protect the area for a day or two and limit activity to that joint
● Apply ice as needed to the injected site for further pain relief
● Watch for signs of infection that include redness, swelling, warmth, and increased pain

How can Physical Therapy Help?
Consistent findings of high-quality randomized control trials have shown that a cortisone injection in adjunct with PT have better long term outcomes than cortisone injection alone or a wait-and-see approach. Success rates for short term outcome measures benefited just the cortisone injection group however recurrence rate was high at long term for just the injection group.

If your doctor has recommended a cortisone injection then request a prescription for physical therapy to insure the best possible outcome. Contact the offices of Sports Rehabilitation Center for any questions or to schedule an appointment.

Mayo Clinic “Tests and Procedures” Cortisone Shots http://www.mayoclinic.org/tests-procedures/cortisone-shots/basics/definition/prc-20014455

WebMD “Arthritis Health Center” Cortisone Injection (Corticosteroid Injection) of Soft Tissues & Joints http://www.webmd.com/arthritis/cortisone-injection-soft-tissues-joints
Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet 2010; published online Oct 22. DOI:10.1016/S0140-6736(10)61160-9

Smidt N, Van der Windt D, Assendelft W, et. al, The Lancet, Volume 359, Issue 9307, Pages 657 – 662, 23 February 2002 Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial