Doctors sometimes recommend cortisone injections to patients experiencing joint inflammation and pain. These steroids, called corticosteroids or cortisone, do not alleviate pain directly. Instead, cortisone injections alleviate joint inflammation, including swelling, heat, and redness, which in turn alleviates joint pain.
The inflammation and resulting pain may be caused by:
- Problems affecting the soft tissue surrounding the joint, such asbursitis and tendonitis
- Conditions that originate inside the joint capsule, such as osteoarthritis, rheumatoid arthritis, or crystalloid diseases such as gout
A cortisone injection will not necessarily treat the underlying condition at the root of these symptoms. For example, osteoarthritis and rheumatoid arthritis can be treated, but not cured. Similarly, a cortisone injection can reduce or eliminate pain from a gout flare-up, but it will not reduce the likelihood of future gout flare-ups.
Why Get a Cortisone Injection?
In general, patients receive cortisone injections for one of two reasons: to treat the condition or to provide information for an accurate diagnosis.
- Treat an arthritic flare-up. For arthritic conditions such as a gout flare-up, a cortisone injection can relieve pain while the gout episode runs its course. The patient may also be prescribed oral medications and be advised to make dietary changes.
- Participate in physical therapy. Pain relief from a cortisone injection gives the patient an opportunity to participate in physical therapy to improve the affected joint's biomechanics. Ideally, by the time the effects of the cortisone wear off, the joint is healthier so pain is tolerable or even eliminated.
- Rest the joint. A painfully inflamed joint needs to rest to recover. For example, patients with an inflamed bursa may need to adequately rest the affected joint in addition to participating in physical therapy.
- Postpone surgery. In moderate to severe cases of arthritis, a joint replacement or another surgical treatment may be recommended. For patients who want to postpone or avoid surgery, cortisone injections may allow them to live with less pain.
Temporary pain relief allows the patient to:
Almost all types of arthritis are chronic, and a cortisone injection is just one part of a larger treatment plan.
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- If the injection relieves the patient's hip pain, the pain probably originates in the hip
- If the hip pain persists even after the injection, the doctor may consider problems affecting spine or the sacroiliac joint (where the spine and pelvis meet), both of which can cause referred hip pain.
- Read more: How Arthritis Causes Back Pain
Cortisone injections for aiding diagnosis
When the underlying cause of pain is uncertain, a doctor may recommend a cortisone shot to help narrow the list of possible diagnoses. This procedure is common in the hip and shoulder joints.
When the underlying cause of pain is uncertain, a doctor may recommend a cortisone shot to help narrow the list of possible diagnoses. This procedure is common in the hip and shoulder joints.
For example, a doctor may recommend a cortisone injection for a patient with persistent, undiagnosed hip pain.
If a diagnosis is still uncertain following a diagnostic injection, the doctor may recommend an MRI or other detailed imaging study.
Of course, an injection meant to aid in diagnosis can be useful for treatment, and vice versa. However, a doctor and patient should take time to discuss the primary purpose of the cortisone injection before it is administered. During this conversation a doctor should let the patient know what part of the joint is being targeted, what are reasonable expectations regarding pain relief, and if follow-up treatment will involve medications, physical therapy, or lifestyle changes.
What is Cortisone?
Cortisone refers to a category of man-made steroids that mimic the effects of cortisol, a hormone that naturally occurs in the body. Both cortisone and cortisol are types of corticosteroids.
It is important to note that these types of steroids differ from anabolic steroids (e.g. testosterone) that are used to enhance athletic performance. Both types of steroids share similar chemical structures but play opposite roles in the body.
- Read more: What is Cortisone?
Not a Cure-All for All Types of Joint Problems
A patient usually receives a cortisone injection to help reduce pain-causing inflammation. Once this inflammation is reduced, the patient can participate in physical therapy (which plays a very important role in most situations). However, cortisone, like all medications, can have side effects.
Most notably, cortisone is known to break down tissues, such as articular cartilage in the joint.1,2 Cartilage is crucial to joint health, acting as a shock absorber and reducing friction between bones when a person moves. Therefore, most physicians will refuse to administer repeated cortisone injections into the same joint over a short period of time, simply because too much cortisone can cause more harm than good.
References
- Dragoo JL. Chondrotoxicity of commonly used single injection corticosteroids. Presented at the 2010 Annual Meeting of the American Orthopaedic Society for Sports Medicine. July 15-18. Providence, R.I. Cited by Orthopedics Today. Preservative noted as possible key to intra-articular injection corticosteroid chondrotoxicity. Helio Orthopedics. www.healio.com. Published September 2010. Accessed February 18, 2014.
- Papacrhistou G, Anagnostou S, Katsorhis T. The effect of intraarticular hydrocortisone injection on the articular cartilage of rabbits. Acta Orthop Scand Suppl. 1997 Oct;275:132-4. PubMed PMID: 9385288.
