“Cortisone Shots” (Steroid Injections)

It delivers a strong dose of anti-inflammatory medicine directly into a painful site.  Examples:

Wrist Tendon

Shoulder

Hip Bursa

Knee Joint

 

 

 

 

 

Two drugs are injected at the same time and fill the joint space, tendon sheath or bursa:

  • A local anesthetic (like Novocain) and a corticosteroid (like dexamethasone).
  • The Novocain numbs the area immediately. This is an important diagnostic test.  If your pain goes away, we know 2 things:
    • This is the structure that is causing your pain
    • The important medicine (the steroid) is in the right place.
  • If the Novocain doesn’t help at all, then it could mean that your pain is coming from somewhere else and we have to consider a different diagnosis.
  • The Novocain will wear off in about 1 hour, and then your pain will probably come back.
  • The steroid should kick in and relieve pain again in about 2 days (could take up to 1 week).
  • 1 in 5 patients experience “rebound pain”, and the area is more painful for 1-2 days until the steroid kicks in. Rest, apply ice, take your medication, move gently…this too shall pass.
  • Other possible side effects:
    • Diabetic patients may have high blood sugar level after the shot. Continue your usual diabetes medicine regimen and it will stabilize within a few days.
    • Flushing/redness in your face and chest. This is not serious and will resolve in 1-2 days.
    • Loss of skin pigment near the injection site is very rare. It will likely resolve in a few months.
    • Risk of infection is very rare. If you have redness, fever >101, swelling and increased pain, call immediately.

 How long will it “last”? 

  • Pain relief from the shot could last for months or years, especially when combined with good habits and basic medications. Your pain will come back if you don’t address the reason it started in the first place.  Use your joints and tendons properly; exercise to keep your muscles and ligaments strong and flexible; manage your weight.
  • If your pain comes back, it might be time for surgery or other treatments (PT, brace, Synvisc for knees?)
  • There’s no hard-fast rule about how often you can have a cortisone shot. Some areas can have only 1 shot.  Some could have 2 or 3 shots per year (at this rate, you’re getting at least 4-6 months of relief).  For patients who can’t have surgery, periodic steroid injections could be a way to control pain over time.

 

Your next step:

  • Follow up in 4-6 weeks to check on your progress; if you’re feeling better, then it’s OK to cancel that appointment.
  • Follow up to check on your progress and review your options.
  • If pain comes back, call for a follow up appointment to review your options (repeat the injection?  PT?  Surgery?)
  • If pain comes back, call to schedule an MRI before your next visit.  Next step might be surgery.