CORTISONE INJECTIONS
What is a Cortisone Injection?
Cortisone is a type of steroid that is produced naturally by a gland in your body called the adrenal gland. Cortisol is released from the adrenal gland when your body is under stress. Natural cortisone is released into the blood stream and is relatively short-acting. Injectable cortisone is synthetically produced and has many different trade names (e.g. Celestone, Depo-Medrol etc.), but is a close derivative of your body’s own product. The most significant differences are that synthetic cortisone is not injected into the blood stream, but into an area of inflammation. Also, when injected, the synthetic cortisone, is designed to act more potently and for a longer period (days instead of minutes). Cortisone is not the same type of steroid as a performance enhancing drug.
How can cortisone injections help?
Cortisone is a powerful anti-inflammatory medication. Cortisone is not a pain-relieving medication; it only treats the inflammation. When pain is decreased from cortisone it is because the inflammation is diminished. By injecting the cortisone into an area of inflammation, very high concentrations of the medication can be given while keeping potential side-effects to a minimum. Cortisone injections usually work within a few days, and the effects can last up to several weeks.
When are cortisone injections used?
Many conditions where inflammation is an underlying problem are amenable to cortisone injections. These include, but are certainly not limited to:
- Shoulder Bursitis and other inflammatory conditions or injuries (Biceps tendinitis, Bursitis, Calcific Tendinitis, Frozen Shoulder etc.)
- Arthritis
- Trigger Finger
- Tennis Elbow
- Carpal Tunnel Syndrome
Is it a painful injection?
The cortisone injection can be slightly painful, especially when given into a joint, but in skilled hands such as Dr van der Berg’s, it usually is well tolerated. Often the cortisone injection can be performed with a very small needle that causes little discomfort. However, sometimes a slightly larger needle must be used, especially if your physician is attempting to remove fluid through the needle prior to injecting the cortisone. Numbing medication, such as Lidocaine or Marcaine, is often injected with the cortisone to provide temporary relief of the affected area. Also, topical anesthetics can help numb the skin in an area being injected.
The most important issue accompanying cortisone injection is to realize that the cortisone injection is merely a powerful anti-inflammatory medication. It will not change any of the underlying risk factors or causes ("drivers") of the condition.
For this reason, cortisone injections can have several outcomes:
- Full resolution of symptoms with no recurrence
- Full resolution of symptoms for minimum or moderate period followed by recurrence
- Minimum -Moderate resolution of symptoms followed by 2-3 further injections at varying intervals
- No change in symptoms
It is likely that people who experience 1 or 2 will give cortisone injections a great rap! At the other end of the spectrum these people will likely give cortisone injections a "thumbs down" and usually go on to tell their friends and anyone else who might be having an injection about the negative experience they have had.
Reasons why a cortisone injection may not have worked could be as follows:
- The condition did not warrant an injection
- The injection missed the inflamed structure
- The structure did not have an inflammatory pathology within it
Isn't cortisone dangerous to me and what are the side effects?
Probably the most common side-effect is a ‘cortisone flare’, a condition where the injected cortisone crystallizes and can cause a brief period of pain worse than before the injection. This usually lasts a day or two and is best treated by icing the injected area. Another common side-effect is whitening of the skin where the injection is given. This is only a concern in people with darker skin, and is not harmful, but patients should be aware of this.
You may also experience some "hot flushes" in your face for a day or two. This is not an allergy and one a minor side-effect.
Other side-effects of cortisone injections, although rare, can be quite serious. The most concerning is infection, especially if the injection is given into a joint. The best prevention is careful injection technique, with sterilization of the skin using iodine and/or alcohol. Also, patients with diabetes may have a transient increase in their blood sugar which they should watch for closely.
Because cortisone is a naturally occurring substance, true allergic responses to the cortisone injections do not occur. However, it is possible to be allergic to other aspects of the injection, most commonly the betadine many physicians use to sterilize the skin.
How much cortisone can I get?
There is no rule as to how many cortisone injections can be given. Often physicians do not want to give more than three, but there is not really a specific limit to the number of injections. However, there are some practical limitations. If a cortisone injection wears off quickly or does not help the problem, then repeating it may not be worthwhile. Also, animal studies have shown effects of weakening of tendons and softening of cartilage with cortisone injections. Repeated cortisone injections multiply these effects and increase the risk of potential problems. This is the reason many physicians limit the number of injections they offer to a patient.