Cortisone Injections

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What are Cortisone Injections?

A cortisone injection is a very powerful anti-inflammatory steroid injection. It can be very effective in relieving pain, swelling and inflammation. It is a different form of steroid to the anabolic steroids used by body builders. It does not help build muscles or have the same side effects.

How long will the cortisone injection take to work?

Cortisone is usually combined with local anaesthetic (LA) to make the injection more comfortable. As a result, the patient often experiences a significant and immediate reduction in pain. The numbing effect of the local anaesthetic wears off after 2-3 hours.

It is extremely variable how long it takes for the cortisone to have its full effect - from a few hours to 3 weeks. Occasionally there is pain and stiffness in the injected joint/soft tissue for a few days following the injection. This is nothing to worry about and is known as 'post-injection flare'. If this occurs, it is best treated by applying ice to the painful area.

Will I need more than one cortisone injection?

This is dependent on the condition being treated. It is common to need regular injections to manage chronic conditions such as knee arthritis. For many conditions such as acute shoulder tendonitis, one injection will be enough to resolve the problem or reduce the pain to a manageable level, so that the patient is able to perform exercises to further reduce pain and disability. Our physio will advise you of the likelihood of you requiring a follow up injection at your appointment. It is common to try a second injection, even if the first provided no/limited relief or short-term relief. If there is minimal relief following the second injection, a third is unlikely to help and therefore our physiotherapist would advise against it and would discuss alternative treatment options.

How many cortisone injections can I have?

Most doctors / physiotherapists use the rule of no more than 3-4 injections in one area within one year. There is evidence that more frequent injections than this in the same area of the body causes damage to cartilage, tendons and ligaments, so should be avoided.

How often can I have a cortisone injection?

There is no universal agreement regarding the minimum period between injections in the same area. If you have limited benefit from the first injection and are still in severe pain, it is appropriate to have a second injection within 4 weeks. For chronic conditions such as knee arthritis, you should try to limit your repeat injections to every 3-4 months.

What are the potential side effects of cortisone injections?

Cortisone injections are widely used in the treatment of joint and soft tissue conditions. Used appropriately, they are safe and effective. Most people have a cortisone injection without any side effects. Significant side effects to cortisone or local anaesthetic are extremely rare. There are certain conditions that would increase the risk of side effects, so we need you to provide a full list of your medical conditions and medications prior to proceeding with the injection. Our physiotherapists will consider your medical history before performing an injection. If it is not appropriate to offer you a cortisone injection, other treatment options will be discussed.

Summary of risks or side effects from having a Cortisone Injection.

Serious side effects are extremely rare and include:

  • Joint and soft tissue infections

  • Anaphylaxis

  • Other potential side effects include:

  • Risk of tendon rupture

  • Local subcutaneous fat atrophy (usually temporary and disappears within a few months)

  • Local discolouration of skin (usually temporary and disappears within a few months, but can be permanent - this is more common with very superficial injections)

  • Post injection flare of pain at injection site.

  • Destabilisation of blood sugars in diabetic patients which require vigilant monitoring by patient following injection

  • Blurring of vision or sudden loss of visual acuity due to very rare complication

  • Facial flushing

  • Menstrual irregularities

  • Dizziness

  • Injury or trauma to neurovascular structures during the injection procedure

  • Very rarely joint damage can occur although usually associated with overly frequent high dose injections

  • Lowering of your body's immune response for a few weeks post injection - particularly relevant at present due to Covid 19

  • Possible short term effect on the effectiveness of vaccinations - as a precaution we recommend 2 week gap between cortisone injection and a vaccination

  • Injury or trauma to neurovascular structures during the injection procedure. Your physiotherapist is highly trained, and will take every appropriate step to avoid injecting or traumatising soft tissue structures, nerves or vessels when performing the injection. However, there is a very small risk that this can occur, particularly with injections at certain locations

  • Summary of risks and potential side effects of local anaesthetics

    Serious side effects are rare and include:

  • Infection - Infection in soft tissue or joint injected

  • Anaphylaxis

  • Loss of consciousness, respiratory depression, respiratory or cardiac arrest.

  • Other potential side effects include:

  • Light headedness

  • Dizziness, drowsiness

  • Blurred or double vision

  • Vomiting

  • Bradycardia

  • Injury or trauma to neurovascular structures during the injection procedure

  • What will happen immediately after my Cortisone Injection?

    You will be monitored for 10 minutes following your injection to ensure you do not have a reaction to the cortisone or local anaesthetic. Please rest assured that our physiotherapists are highly trained at administering the injections and in dealing with any side serious side effects if they were to arise, which is extremely unlikely. We hope you understand that it is our legal obligation to advise you regarding anything that could possibly go wrong, however unlikely. Cortisone and local anaesthetic injections are a safe and effective treatment for many painful conditions.

    Our physiotherapists are happy to discuss any further questions / concerns you have regarding a cortisone injection before you book an appointment. Please call our booking line on 03456 252 252 to speak to a chartered physiotherapist.

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