Definition and Overview
A cortisone injection, sometimes referred to as a steroid shot, is a highly effective medication used in the treatment of inflamed joints. It works by toning down the effects of an overactive immune system, such as swelling.
Cortisone is a type of man-made steroid that features anti-inflammatory and anti-allergy properties. Although it is highly effective, it also presents a wide range of side effects mostly because it imitates the body’s production of natural hormones, which could lead to the development of hormonal imbalance over time. As such, patients are only given such medications in limited amounts over a certain period.
Who Should Undergo and Expected Results
Cortisone injections are usually prescribed to patients with osteoarthritis or rheumatoid arthritis, primarily as an anti-inflammatory agent. The injections also bring a long-lasting pain relief.
While steroid shots may seem like the perfect solution for joint related problems, they are not advisable for all types of joint problems. One of the side effects of cortisone is the breakdown of tissues, such as articular cartilage. Cartilage acts as shock absorbers and reduces friction between the bones. Reducing the amount of cartilage in a joint can have drastic effects.
Therefore, cortisone injections are usually only recommended after performing a variety of tests to ensure that the joints are strong enough to handle such medication. If the doctor believes that the medication can actually do more harm than good, other treatment methods will be considered.
Cortisone injections can provide relief from inflammation for up to 6 months. During this period, pain is also significantly reduced, allowing the patient to perform normal daily activities or even undergo physical therapy for the affected limb.
Cortisone injections are usually prescribed for patients with osteoarthritis, rheumatoid arthritis, tennis elbow, gout, lupus, tendinitis, carpal tunnel syndrome, bursitis, and myofascial pain syndrome.
The injections may also be administered when the cause of pain is difficult to determine. Once inflammation and pain have been reduced, the area can be tested more closely to diagnose the exact cause and determine the appropriate form of treatment.
How Does the Procedure Work
Not much needs to be done to prepare for a steroid shot. However, doctors usually advise patients to stop any medications or supplements that have blood-thinning effects as these can cause bleeding or bruising, a few days prior to receiving the injection. On the day that the medication is to be administered, the patient will first need change into a hospital gown so the doctor has better access to the site. The area will then be cleansed using an antiseptic. The doctor may also administer an anesthetic to make the procedure more comfortable.
Cortisone injections need to be administered precisely, which is why a doctor may opt to use an ultrasound device to help guide the needle to the exact location of the joint.
Patients should expect minor discomfort when the needle is inserted, but this should only be temporary. The anaesthetic should be able to manage most of the pain, and other medications will be provided to increase patient comfort after the cortisone injection.
Patients usually experience different symptoms, such as redness at the injection site or a general feeling of warmth after a steroid shot. There could also be a temporary increase in blood sugar levels, so this also needs to be monitored.
Patients will then be advised to rest the area for a few days after the shot for maximum effect. Any pain can be managed by applying ice or taking over-the-counter pain medications. Doctors will usually advise patients to monitor the injection site for any signs of infection, such as swelling and redness that lasts more than a couple of days.
Possible Risks and Complications
Cortisone injections do carry a number of risks and possibilities of complications, mainly because steroids have a hormonal effect on the body. Aside from hormonal imbalance, which should be manageable by limiting the amount of cortisone a patient receives within a given period, there is also a possibility of osteonecrosis or the death of the nearby bones.
Other possible complications are osteoporosis, nerve damage, and infections at the joints or the site where the injection was administered. Tendons in the area might also be affected by the medication causing them to weaken or rupture.
Roberts WN. Intraarticular and soft tissue injections: What agent(s) to inject and how frequently? http://www.uptodate.com/home.
Firestein GS, et al. Kelley's Textbook of Rheumatology. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2013. http://www.mdconsult.com/das/book/body/208746819-6/0/1807/0.html.