Facts and myths about cortisone injections

Cortisone injections are commonly used to treat the pain caused by inflammation of joints, tendons, and other soft tissues.

The inflammation is usually chronic meaning that it has been present for a long time. Arthritis is an example of this.

Let’s begin with the facts of cortisone injections.

Since health care providers are doing our best to avoid prescribing narcotics these days, a cortisone injection may be one form of treatment that we will recommend to people suffering from chronic inflammation. Cortisone, a corticosteroid, is often referred to as a "steroid" injection.

Corticosteroids work by blocking the body’s production of substances that produce inflammation. If the underlying cause of the inflammation is not dealt with, the inflammation will eventually return. Therefore, cortisone shots represent a form of treatment and do not cure the condition.

I like to use the analogy of diabetes. Insulin can be used to treat diabetes but does not cure it. Cortisone will treat your knee arthritis but will not cure it. In both conditions, the treatment has to be repeated to keep it under control.

It is quite natural for a person to be fearful the first time they hear that they should consider a cortisone injection. Usually, the first question I get is, "Will it hurt?" The answer is yes.

However, much can be done to minimize the pain such as spraying the skin with ethyl chloride. This will cool the skin and has a numbing effect. A local anesthetic can also be injected with the cortisone to decrease the pain. The pain of the shot will usually last five seconds or less. This fact alone should convince a person that the benefit of decreasing or relieving the constant pain outweighs the brief pain of the shot.

In most cases, the effect of the cortisone will be felt within three to five days. As long as the relief lasts for three months or longer, the shots can be repeated indefinitely.

Over the course of time, they will usually become less effective and may eventually be of no benefit at all. This usually means that the arthritis has progressed to a more advanced stage and it may be time to discuss surgery such as a joint replacement.

The most common side effect of a cortisone injection is to cause a temporary elevation of blood sugar levels in a diabetic. If you do not have diabetes, the shot not will affect your blood sugar. One or two nights of insomnia and flushing of the face can occur. The person may look like they have mild sunburn. If a joint such as a wrist or a tendon is injected, there is a rare chance of causing a permanent dimple or bleaching of the skin at the site of the injection.

The two most serious side effects are infection (very rare) or bleeding into the area injected. Bleeding is also an unusual occurrence unless you are on a blood thinner so be sure to let your doctor know before you get the shot if you are on one.

Cortisone will not damage your joints if used in the correct dose and frequency. If too much cortisone is used or if cortisone is used too often, it can damage ligaments or soften bones. That is why you should not have the same joint injected any sooner than three months since the last time. However, a different joint can be injected at less than three months’ time without worry.

Dr. Philip Hurley is a board-certified orthopaedic surgeon and member of OSMO who sees patients in Ohio County. If you are experiencing muscle or joint pain and would like to schedule an appointment with Dr. Hurley, please call (270) 730-5344. To schedule an appointment with one of the board-certified orthopaedic surgeons at Orthopaedics & Sports Medicine Owensboro (OSMO) in Owensboro, please call (270) 926-4100.

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