Cortisone injections

Who hasn't heard a horror story about how much a cortisone injection hurts? Well below are some facts from the Arthritis Foundation of New Zealand.

Cortisone, is a substance similar to a natural steroid hormone produced by the body. It reduces inflammation, (pain, heat, redness and swelling) of joints and their surrounding structures. Special preparations are used to prolong its effect at the site of injection. Cortisone starts to act slowly over 25-36 hours and the beneficial effects may last for days or months.

When is a Cortisone injection given?

  • When pain due to inflammation is prominent either in a joint or the surrounding structures.
  • If only a few joints are involved.
  • If specific joints are preventing activity.
  • If other medication can not be used.

Local anaesthetic may also be given. This relieves pain immediately and lasts for 3 - 4 hours while the cortisone is beginning to work.

How Often?

Discuss this with your doctor.

As a general rule:

  • In a joint, no more than once a month, with a maximum of 3 - 4 cortisone injections in one year.
  • In the surrounding structures, no more than once every 2 - 3 weeks.

What are the benefits?

  • Pain and swelling are reduced
  • Mobility is increased
  • Often, as the pain settles, other medication can be reduced
  • It may be combined with other treatment such as physiotherapy.

After your treatment

  • Rest the joint for about 24 hours
  • Avoid excessive movement or stress on the joint for about one week.

This prolongs the action of the cortisone in the joint or surrounding structures.  Sometimes there is increased pain after the injection which settles within 24 hours.

If there is pain:

  • Rest
  • Apply ice (in a plastic bag wrapped in a towel)
  • If the pain worsens over 48 hours and/or you feel unwell


Side effects - How Cortisone injections differ from Cortisone tablets

As cortisone is injected infrequently into a specific site, very little enters the blood stream compared with the cortisone taken in tablets. Because of this "cortisone side effects" are minimal. However other joints may temporarily improve as the cortisone slowly enters the blood stream.

Cortisone side effects are very uncommon, they include:

  • Flushing
  • Swelling of fingers or face (oedema)
  • Menstrual irregularity
  • Mood change
  • Raised blood pressure
  • Thinning (atrophy) or altered colour of the skin at the site of injection. This rarely occurs with joint injection but may with injections of the surrounding structures e.g. Tennis Elbow
  • Raised of unstable blood glucose levels in diabetes for several days following the injection.