Search

PT Myth Busters: Are Cortisone Shots Always a Good Option?

This week’s blog is about something that comes up often in the clinic, Cortisone shots. Weekly, we get asked “should I get a Cortisone shot?,” “are Cortisone shots dangerous?,” “Should I avoid cortisone shots?,” and a few other questions related to Cortisone shots. So, what is the truth about Cortisone injections?


First of all, what is a Cortisone shot exactly?

Cortisone is a synthetic version of cortisol, a steroid produced in our adrenal glands and released into the bloodstream in response to stress. Cortisone is anti-inflammatory and acts to suppress the immune system and reduce inflammation in irritated tissues. It will often be injected with Lidocaine, a local anesthetic that acts to numb areas and reduce pain.

Cortisone doesn’t actually heal the underlying problem triggering the inflammation, it just reduces the inflammation itself. Some patients feel pain relief immediately with a Cortisone shot, for others it takes weeks, and for some, they feel no different or sometimes even feel worse.


When are Cortisone shots potentially helpful?

Cortisone shots can be helpful in an isolated area of pain, such as a knee joint or shoulder joint, when you’re having a hard time getting that immediate pain relief otherwise. If you’ve already tried some PT and need that little extra something to get over the initial hurdle of pain and immobility, it may be helpful.


Cortisone shots can also act as a differential diagnosis tool. If an Orthopedist is unsure what joint is causing the pain, or if they can’t tell if the issue is an inflammatory issue vs. something else, they may use a Cortisone shot into one specific joint to see how the patient responds and get a better idea of what’s going on.


What are the potential dangers of Having One Cortisone shot?

According to Harvard Health/Harvard Medical School, injected cortisone, which is often combined with lidocaine, can clump into crystals and may worsen pain rather than relieve it. Small amounts of cortisone that have been injected into a joint can get into the bloodstream and rest of the body and have hormone-like effects that make diabetes harder to control. There’s also a small risk of a Cortisone injection actually causing joint infection.


What are the dangers of having repeated Cortisone Injections?

According to research summarized by the Mayo clinic, repeated and larger doses of Cortisone shots can have these side-effects:

  • Cartilage damage

  • Death of nearby bone

  • Nerve damage

  • Joint infection

  • Facial flushing

  • Temporary flare of pain and inflammation in the joint

  • Temporary increase in blood sugar levels

  • Tendon weakening or rupture

  • Thinning of nearby bone, potentially leading to localized osteoporosis

  • Thinning of skin and the soft tissue at the injection site

  • Whitening or lightening of the skin around the injection site


Given all this information, is a Cortisone shot right for me?

This will be a personal choice, given the information provided here and by your Orthopedic specialist. But this is what I tell my patients in the clinic: It is totally fine to get one or maybe two Cortisone shots into a single joint if it’s needed to get past the hump of moderate-severe, constant pain and immobility. It can be helpful in these cases to calm the area enough to allow the rehabilitation process to progress.

<