Cortisone Shots

Cortisone shots are used to treat a variety of conditions that can affect joints. Administering the steroid via injection helps to alleviate pain at that site. Additionally, it reduces inflammation by tempering down the effects of the immune system. Based on a patient’s particular condition, a mixture of steroid and anesthetic will be injected into the joint itself or a specific area of the surrounding soft tissue.

Conditions that can benefit from Cortisone Injection Therapy

Many issues involving joint pain and decreased range of motion are caused by diseases that trigger inflammation. Additionally, issues with nerves that run in and around joints may also contribute to joint pain. Common conditions that may benefit from Cortisone shots include:

• Arthritis Inflammation in one or more joints causes pain and stiffness. There are many types of arthritis including:
  • Osteoarthritis: cartilage in the joint
  • rheumatoid arthritis: autoimmune disease, meaning the body’s immune system attacks itself, specifically the lining of joints
  • psoriatic arthritis: autoimmune disease targeting the connective tissue of joints that also triggers a skin disease called psoriasis
• Tendonitis Tendons connect muscles to bone. Inflammation in this connective tissue is referred to as tendonitis. Damage can occur due to a variety of factors such as trauma or overuse by repetitive motions.
• Compressed nerves Various nerves can become compressed or pinched. In addition to pain, they can elicit strange sensations of numbness or tingling. Pressure, leading to compression, can come from damage sustained from trauma, from repetitive motions, or from inflammation of surrounding tissues due to other issues. Carpal tunnel syndrome and Cubital tunnel syndrome are examples of conditions caused by compressed nerves.
• Gout Gout is a specific type of arthritis that happens as a result of a buildup of uric acid. It is most commonly affects the feet.
• Bursitis: The bursae are the fluid-filled sacs that protect the “pointy” parts of joints. Bursitis occurs when the sac becomes inflamed. This can be due to either trauma or infection.

Common Medications Used

There is no strict guideline as to which glucocorticoid is the “gold standard”. Physicians make their decisions based on a variety of factors. However, the following steroids are the most commonly used with similar rates for each:

• Methylprednisolone acetate
• Triamcinolone acetate
• Triamcinolone acetonide

The amount of steroid necessary will vary depending on the location where the cortisone injection will be administered. The smaller the area being targeted, the less the dosage of the steroid is needed. Too much of a steroid at a specific site can cause damage in the form of atrophy.

Anesthetics can be mixed in, such as lidocaine. There are several benefits to adding an anesthetic to steroid shots:

• Lowers the concentration of steroid, making it less likely to cause atrophy
• Provide immediate pain relief, giving the steroid time to metabolize and give a greater overall effect later
• Less likely the steroid will cause localized irritation before its positive effects are felt

How often should cortisone injections occur?

As with many medical treatments, the frequency with which a medication is administered depends on the patient’s condition and corresponding location. There are currently no absolute recommendations for the frequency of injections. Most health care providers will limit the number of injections to 3-4 per year.

Generally speaking, steroid use (including injections) should not be continually administered over an extended period of time unless specifically recommended by your medical professional team. These types of shots are usually limited to a couple of years of use. However, most medical professionals recommend limiting the use of these shots to the minimum amount needed. This is due to the propensity of the side effects to start outweighing the benefits.

Possible Sides Effects of Cortisone Shots

• Atrophy As mentioned previously, if steroids are administered too many times or the concentration is too high, it can result in damaged tissues
• Increased Blood Sugar Levels Patients with diabetes should be cautioned against steroids, as they can contribute to increased blood sugar levels. These should be avoided, particularly if a patient does not have their blood sugar levels well regulated.
• Infection Any time a procedure introduces a substance into the body, there is a slight chance of infection. As with any similar medical procedure, maintaining sterility is the main way to prevent infections. Types of infections include:
  • Periarticular infection: when a foreign substance (usual a pathogenic germ) is introduced into the joint via the injection
  • Patients than plan on having total joint replacements should not have steroid injections as they are at an increased risk of infection.
  • Patients will pre-existing infections (such as septic arthritis) should not receive steroid injections, as the infections can be made worse.
• Pain at the injection site Any injection of a medication comes with a small risk for pain at the site where the injection was administered. Steroid injections that have a small amount of anesthetic included help to prevent pain at the site.
• Impeding Bone Repair Patients that have small fractures within a particular joint should not get steroid shots, as glucocorticoids may prevent the bone from healing.
• Decreased bone density If a patient has (or is at risk of developing) osteoporosis, steroid shots are not recommended.
• Joint Instability: As mentioned previously, steroid shots can possibly cause muscle weakening (atrophy) and decreased bone density. Therefore, it is possible that steroid injections can contribute to joint instability or make it worse.
• Less common side effects include: stomach issues, hypertension, and skin issues

Alternative Injectable Medications:

• Stem cell injection Stem cells are power agents that can help your body heal and regenerate. Orthopedic science literature has published many studies on the benefit of using stem cell therapy to heal knee pain, shoulder pain, rotator cuff injuries, meniscal injuries.
• Platelet-rich Plasma Platelets are a component of blood and plasma is the liquid portion of blood. Platelets contain growth factors that help the process of healing. Patients using PRP have their blood drawn, their platelets concentrated in their plasma and then it is injected back into the patient. There is evidence that this can be helpful for tendonitis related issues but there is no current evidence for other joint pain conditions.
• Hyaluronic acid derivatives Hyaluronic acid helps to curb inflammation and is naturally found in the skin and joints. It has been found to be effective for reducing pain due to osteoarthritis of the knee, but there is little evidence that it is effective as an injectable for other inflammation-related conditions of the joints.
• There are a number of additional experimental agents such as anti-rheumatic drugs and liposomes.

Although they have substantial limitations, Cortisone shots can be helpful in reducing joint pain and inflammation for a variety of conditions.

Treatment options for sports injuries is best achieved through a combination of injection in conjunction with graded rehabilitative exercise. Individual programs may include a cortisone shot, regenerative medicine, PRP injection, PRP treatment or stem cell therapy which boosts the body’s natural ability to heal.

If your pain does not resolve after a brief period, contact us so that we may help diagnose the problem and treat the underlying cause.  Do not let pain persist or else it may become chronic.