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Cortisone injections

Key points about cortisone injections

Cortisone injections (also called steroid injections) are used for joint problems and arthritis.
They involve the injection of cortisone medication such as triamcinolone, dexamethasone or methylprednisolone directly into a joint space or soft tissue to reduce inflammation (swelling) and pain.
Find out how they are given and possible side effects.

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Cortisone is a substance similar to a natural steroid hormone produced by the body. Cortisone injections are given into a painful joint, soft tissue or bursae (fluid-filled sacs that cushion spaces around and between your joints, tendons and bones) to reduce pain and swelling.

They're used in conditions such as bursitis, frozen shoulder, gout, rheumatoid arthritis, osteoarthritis, tendinitis, carpal tunnel syndrome, rotator cuff damage, tennis elbow and trigger finger.

Cortisone injections are used when there is a flare-up or the pain isn't responsive to other treatments, or when other medicines can't be used.

They provide short-term pain relief, usually for up to a month, but don't cure the problem or improve joint function or stiffness.

Video: Cortisone injection

(RheumInfo, Canada, 2011)

Note: this video is from Canada so may have information that differs from New Zealand recommendations.

Avoid regular repeated injections

Cortisone injections are used as short-term relief. Regular repeated steroid injections aren't recommended. Frequent injections into the same area can cause the bone, ligaments and tendons to weaken over time.

Generally, cortisone injections aren't given more often than 3 or 4 times a year and they are given at least 6 weeks apart.

The following are examples of cortisone injections available in Aotearoa New Zealand:

Betamethasone (Celestone Chronodose®).
Dexamethasone (Dexamethasone-hameln®).
Methylprednisolone (Depo-Medrol®).
Triamcinolone (Kenacort-A®).

Before giving the cortisone injection, your healthcare provider will remove excess fluid from the joint using a syringe and needle.
The fluid is examined by your healthcare provider and a sample is sent to the laboratory for diagnosis.
Removing the fluid reduces pressure in the joint. This helps relieve pain and may encourage the joint to heal.
A separate syringe and needle are then used to give the cortisone injection.
The cortisone slowly starts to act over 24 to 36 hours. The beneficial effects may last for days or months.
A local anaesthetic may also be given. This helps relieve pain immediately and lasts for 3 to 4 hours while the cortisone is beginning to take effect.

Care after the injection

After you've had a cortisone injection, rest the joint for about 2 days and avoid excessive movement or stress on the joint for about 1 week.
Sometimes there is increased pain in the joint after the injection which settles within 24 hours. To relieve the discomfort rest, apply ice and take pain relievers such as paracetamol (or as advised by your healthcare provider).

Like all medicines, cortisone injections can cause side effects, although not everyone gets them.

Side effects	What should I do?
Where the steroid was injected you may have pain, bruising and swelling	This can last for up to 3 days after the injection but should go away after this. Rest the area and apply ice. Talk to your healthcare provider about pain relief medicines.
Flushing in the face and chest (looks red and feels warm) Swelling of fingers or face Problems sleeping Feeling full of energy Short term changes to your menstrual periods	These usually only last for a few days until there is less cortisone in your body. Tell your healthcare provider if these bother you.
Mood changes	These are not common at standard doses. They can be mild changes like feeling irritable or anxious. If you are experiencing changes including feeling depressed or suicidal tell your healthcare provider immediately.
Where the steroid was injected you may have: paler or darker colour of the skin dimpled skin	This is more common if you have cortisone injections more than once or if the injection is near the surface of the skin. Discuss with your healthcare provider if this is a concern.
Raised blood glucose levels for several days following the injection	If you have diabetes, you may need to check your blood glucose level more often and/or increase the dose of your diabetes medicine to control your blood glucose. Talk to your healthcare provider about this.
Blurred vision Sensitivity to bright light Changes in vision	This is rare but serious. Tell your optometrist or healthcare provider immediately.
Signs of infection, such as a hot and swollen joint, feeling unwell, fever and severe pain that doesn't go away after 48 hours or pain that develops after this time	There is a small risk of infection following a cortisone injection. Infection in a joint can be serious, so it's important to get medical advice as soon as possible if you get any of these symptoms.

Gout | Mate waikawa kai kōiwi
Rheumatoid arthritis | Mate rumatiki
Osteoarthritis | Pona ngoikore
Tendinitis
Tennis elbow

The following links have more information on steroid injections. Be aware that websites from other countries may have information that differs from New Zealand recommendations.

Steroid injection(external link) Rheuminfo
Celestone Chronodose(external link) Medsafe Consumer Information, NZ
Kenacort-A(external link) Medsafe Consumer Information, NZ
Steroid Injections(external link) Patient Info, UK