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Corticosteroid (Cortisone) Injections

Corticosteroids are a type of medication related to cortisone, a steroid.

Medications of this class are used to reduce the inflammation caused by a variety of diseases and conditions. They are not painkillers which mask pain without addressing the most common cause-inflammation.

Cortisone is one type of a corticosteroid. For the purpose of this review, "cortisone" is used interchangeably with "corticosteroid."

Cortisone can be taken by mouth, inhaled, applied to the skin, given intravenously, or injected into various tissues of the body.

Examples of corticosteroids include prednisone and prednisolone (given by mouth),methylprednisolone injection (Solu-Medrol) (given intravenously), as well as dexamethasone (Decadron), triamcinolone (Kenalog), betamethasone (Celestone), and methylprednisolone (Depo-Medrol) which are given by injection into various body tissues.

A distinct benefit of a corticosteroid injection is that the relief of localized inflammation in a particular body area is more rapid and powerful than with traditional anti-inflammatory medications given by mouth, such as Motrin or aspirin.

A single injection also can avoid certain side effects that can accompany many oral anti-inflammatory medications including stomach irritation.

Other advantages include a rapid onset of action, dependability, and minimal side effects.

Cortisone injections can offer reliable and durable relief of inflamed joints, tendons, bursa and nerves for many people.

Examples of common types of conditions treated with cortisone injections include, but is not limited to, bursitis in the extremities, pinched nerves in the spine or extremities, and tendonitis in the extremities.

When administered by an expert, cortisone injections can offer significant relief of pain usually with minimal discomfort.

They are not usually performed in treatment isolation but as part of a broader rehabilitation plan that addresses the cause of the pain.

They are not meant to be performed routinely or repeatedly. Their use should be limited to reduce risks and potential side effects.

Resting the joint, bursa, nerve or tendon after the injection is important to allow the inflammation to decrease.

Formal exercise involving the injected area should be avoided for several days following the injection.

Disadvantages of cortisone injections are the necessity of piercing the skin with a needle as well as potential short- and long-term side effects. It should be emphasized that though each of these side effects is possible, they usually never occur.

Short-term (1-5 days) cortisone injection side effects are uncommon but include:

  • local bleeding from broken blood vessels in the skin or muscle soreness at the injection site
  • aggravation of inflammation in the area injected because of reactions to the corticosteroid medication (post-injection flare)
  • facial flushing
  • sweating
  • insomnia
  • mood swings
  • increased appetite
  • menstrual changes
  • restlessness
  • hiccups
  • headache
  • extra energy
  • upset stomach
  • frequency urination
  • slight fever (99-100 degrees) with flu-like symptoms
  • elevation of blood glucose in those with diabetes
  • reduced ability to fight infections.

Long-term side effects of corticosteroid injections are much rarer than short term side effects.

With higher doses and frequent administration, which increase secondary total body exposure to the corticosteroid, potential complications become more likely and include:

  • thinning of the skin and lightening of the color (depigmentation) of the skin if the injection site is close to the surface
  • easy bruising
  • weight gain
  • puffiness of the face
  • acne
  • cataract formation
  • weakening of the tendons especially with repeated corticosteroid injections administered near tendons
  • thinning of the bones (osteoporosis)
  • a rare but serious type of damage to the bones of the large joints (avascular necrosis or osteonecrosis)