What is a cortisone injection?

A cortisone injection is a very powerful anti-inflammatory steroid injection and can be very effective in relieving pain, swelling and inflammation associated with a wide range of Musculoskeletal (MSK) Injuries / Conditions. Cortisone injections cause far less side effects than taking regular anti-inflammatory tablets and strong painkillers for painful joints and soft tissues.

Research shows that Cortisone Injections are extremely effective in providing rapid and significant pain relief in a wide variety of joint and soft tissue injuries. The pain relief experienced following a Cortisone Injection provides a window of opportunity for you to perform rehabilitation exercises to make the injured area stronger and more flexible.

Frequently Asked Questions

How long will the cortisone injection take to work?

Cortisone is usually combined with local anaesthetic (LA) to make the injection more comfortable. As a result, the patient often experiences an immediate reduction in pain. The numbing effect of the local anaesthetic wears off after 2-3 hours.

It is extremely variable how long it takes for the cortisone to have its full effect - from a few hours to 3 weeks. Occasionally there is pain and stiffness in the injected joint/soft tissue for a few days following the injection. This is nothing to worry about and is known as 'post-injection flare'. If this occurs, it is best treated by applying ice to the painful area and taking analgesia.

Our Injection Specialist will only recommend proceeding with an Ultrasound-guided Cortisone Injection, if it is deemed appropriate for your injury/condition, based on his extensive experience and current research. However, it is very important for you to understand, that even though a Cortisone Injection is often highly effective in addressing pain and stiffness, it is not guaranteed to work.

Will I need more than one cortisone injection?

This is dependent on the condition being treated. It is common to need regular injections to manage chronic conditions such as knee arthritis. For many conditions such as acute shoulder tendonitis, one injection will be enough to resolve the problem or reduce the pain to a manageable level, so that the patient is able to perform exercises to further reduce pain and disability. Our physio will advise you of the likelihood of you requiring a follow up injection at your appointment. It is common to try a second injection, even if the first provided no/limited relief or short-term relief. If there is minimal relief following the second injection, a third is unlikely to help and therefore our physiotherapist would advise against it and would discuss alternative treatment options.

How many cortisone injections can I have?

Most doctors / physiotherapists use the rule of no more than 3 injections in the same area (e.g. Right shoulder) within one year. There is evidence that more frequent injections than this in the same area of the body causes damage to cartilage, tendons and ligaments, so should be avoided.

It is possible to have a Cortisone Injection in 2 or more locations in the same consultations.

How often can I have a cortisone injection?

There is no universal agreement regarding the minimum period between injections in the same area. If you have limited benefit from the first injection and are still in severe pain, it is appropriate to have a second injection within 4 weeks. For chronic conditions such as knee arthritis, you should try to limit your repeat injections to every 3-4 months.

What are the potential side effects of cortisone injections?

Cortisone injections are widely used in the treatment of joint and soft tissue conditions. Used appropriately, they are safe and effective. Most people have a cortisone injection without any side effects.

Significant side effects to cortisone or local anaesthetic are extremely rare. There are certain conditions that would increase the risk of side effects, so we need you to provide a full list of your medical conditions and medications prior to proceeding with the injection. Our physiotherapists will consider your medical history before performing an injection. If it is not appropriate to offer you a cortisone injection, other treatment options will be discussed.

You will be monitored for 10 minutes following your injection to ensure you do not have a reaction to the cortisone or local anaesthetic. Please rest assured that our physiotherapists are highly trained at administering the injections and in dealing with any side serious side effects if they were to arise, which is extremely unlikely. We hope you understand that it is our legal obligation to advise you regarding anything that could possibly go wrong, however unlikely. Cortisone and local anaesthetic injections are a safe and effective treatment for many painful conditions.

What does the research say?

Research consistently shows that Ultrasound-Guided Cortisone Injections are highly effective in the management of pain related to a wide variety of chronic/persistent injuries and conditions. Even patients with pain related to severe joint arthritis can expect significant relief of symptoms. The research consistently shows that Cortisone Injections are the most effective injections in providing rapid and significant pain relief.

What is our injection specialist Gareth Tremain's opinion on cortisone injections?

Ultrasound-Guided cortisone injections can be a highly effective treatment for a wide variety of persistent and painful conditions. Their use should be considered when conservative treatments have failed to provide adequate pain relief and the patient's function and quality of life is affected. I have spent many years training to be able to perform Ultrasound-Guided Cortisone Injections. This study has certainly been worth it. I see on a daily basis how these injections can provide significant pain relief and improve function, when all other treatments have failed.

I recommend ultrasound-guided cortisone over ultrasound-guided hyaluronic acid injections if the severity of pain is high and there appears to be a significant inflammatory element to the patient's symptoms.