Are cortisone injections any good?

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by Harry Brownlow, October 2017

Are cortisone injections any good?

I have just read a really nice article from my shoulder colleagues in Cardiff (Tim Matthews and colleagues, Shoulder and Elbow Journal, 2017). It made me think about some of the common issues surrounding cortisone injection.

‘Aren’t cortisone injections really bad for you?’, ‘I heard cortisone injections really hurt’, ‘cortisone injections are just masking the underlying problem’.

These are common objections I hear when offering a cortisone injection for specific shoulder problems.

I believe that cortisone injections, mixed with local anaesthetic, have 3 major benefits

The type of cortisone we inject into a joint is a synthetic version of a natural steroid. It acts as a powerful anti-inflammatory drug and is usually much more effective than non-steroidal tablets or non-steroidal creams.  I believe that cortisone injections, mixed with local anaesthetic, have 3 major benefits.

The first is that they can be therapeutic; that is they can cure rather than just temporarily relieve the painful symptoms of the underlying problem. For example they are very effective in conditions which have a major inflammatory component such as adhesive capsulitis (frozen shoulder), rheumatoid arthritis, post injury inflammation, and acute calcific tendonitis.

The second major benefit is as a diagnostic tool. If there is definite symptomatic benefit, even if relatively short lived, following an ultrasound guided injection, then that is good evidence that the site injected is likely to be the cause of the current problem. This can be really helpful when there is uncertainty about the source of the pain. For example, it can be surprisingly hard to tell whether shoulder pain is arising from trouble in the shoulder or neck. If there is a definite response to a shoulder injection then that injection has been a very helpful diagnostic tool.

the cortisone injection can provide a pain free window to engage in therapeutic physiotherapy

The third, and commonest benefit, is for the cortisone injection to provide a pain free window of opportunity to engage in therapeutic physiotherapy. So even if the cortisone injection does not cure the underlying problem it can provide a respite from pain for several weeks or months. During this time it is possible to fully engage in physio and other treatment plans which were just too painful previously. Often by the time the injection has worn off the treatment plan has worked so that the painful symptoms have been cured. In this way 75% of people were successfully treated and avoided operation in Cardiff.

Are they bad for you? No. As long as the injection is put in the right place (we use ultrasound to help guide the injection) then they are very safe.

How many can I have?  It depends on a number of factors but the current recommendation is for no more than 2 or 3 cortisone injections per site per year. If you find yourself needing more than this then you should think about changing to a more definitive type of treatment.

Does the injection hurt? Yes, but not as much as you fear! However I in 3 people will experience a post injection flare of pain. This typically lasts up to 4 days. It is not serious and usually responds to simple pain killers.

How long do they last? That is really hard to answer. It can be hugely variable from being no help at all to curing the problem for ever to something in between. Most people feel they get many weeks or even several months of benefit.

Overall I find cortisone injections, given in the right way and for the right reasons, are hugely beneficial and that their minimal risks are easily outweighed by their dramatic benefit.  I believe that their use helps us treat the majority of shoulder problems without having to resort to surgery.