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cortisone shot in the knee

What Is a Cortisone Injection?

By: Nicholas Slenker, MD   December 19, 2018
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Cortisone injections (also known as steroid shots) are frequently used to reduce inflammation and associated pain. They are most commonly injected into a specific area in the body to target a particular joint or tendon. The injections are usually compromised of a corticosteroid medication, which is typically mixed with a local anesthetic. Cortisone is most effective in treating conditions that cause inflammation in and around the joints, including osteoarthritis, bursitis, tendonitis, gout, and rheumatoid arthritis.

When Will a Physician Recommend a Cortisone Injection?

After treatments such as rest, stretching, and other anti-inflammatory medications have been used without success to relieve pain, cortisone injections are frequently recommended and can be very helpful. Symptom relief can last anywhere from six weeks to six months after a cortisone injection. However, because of potential side effects, the number of injections that you get in one year is generally limited and they must be spaced apart.

What Can Patients Expect?

A cortisone injection can usually be administered in a doctor’s office and takes less than five minutes. You will generally be positioned so that the doctor can easily insert the needle into the target joint or tendon. The injection is usually guided by anatomic landmarks, however, we do occasionally use the guidance of ultrasound or X-ray for areas more difficult to reach.

The area around the proposed injection site is cleaned with an antiseptic. We also typically use an anesthetic spray to numb the area where the needle will be inserted. Like any injection, it may be mildly to moderately painful. Patients typically feel a pinch followed by a burning sensation that dissipates quickly. After the cortisone injection, there are few limitations, but we typically ask the patient to rest the area for a day or so, as not to overdo it and allow the medication to take effect. This would include the avoidance of heavy lifting after a shoulder injection or prolonged walking after a knee injection. I also recommend applying ice to the area a few times a day for the first 24-48 hours to relieve any pain.

What Are the Complication Risks?

While complications from cortisone injections are rare, there are some potential risks. Potential side effects include a temporary increase in pain and swelling after the injection, which is typically referred to as a cortisone flare. This usually lasts one to two days and can be treated with rest and ice. There is also some risk of skin discoloration, or lightening, around the injection site. Additionally, there is a risk of a temporary elevation in blood sugar, which is of particular concern in diabetics. Though rare, it is possible for the injection site to become infected.

There is also a more general concern that multiple cortisone injections into the same area can accelerate the degeneration of soft tissue, possibly causing more damage to cartilage, bone, or tendons. For this reason, injections need to be spaced out by at least six to eight weeks apart and you shouldn’t get more than four injections per year in the same location. And while high doses of steroid can cause destruction, when used in the appropriate way, a single shot can be very helpful in limiting a severe inflammatory response that can cause tissue destruction if left untreated.

Dr. Nicholas Slenker is an orthopedic surgeon who specializes in treating knee and shoulder injuries and pain. 

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Keywords

knee replacement, orthopedics, shoulder, knee