Are Cortisone Injections Bad for You?

I give many cortisone injections in my practice because cortisone is a powerful, effective anti-inflammatory.  Most shoulder problems are the result of inflammation, and cortisone is the most effective medication to treat inflammation.  Period.  Why do I use cortisone injections?  Because they work really, really well.  Like any medication, though, cortisone has benefits and risks.  Here I will try to answer common questions about cortisone injections.

First, what is cortisone?  Actually, cortisone is just one of many medications in a group called corticosteroids.  Other corticosteroids include prednisone, prednisolone, methyprednisolone (medrol), and dexamethasone.  Most people just say cortisone to mean any of these medications.  Cortisone and the other corticosteroid medications work by decreasing the body's immune response--it is an anti-inflammatory. Inflammation is the immune system flaring out of control and causing pain.

Is cortisone just a "temporary fix"?  For many people, a single cortisone shot is an effective, permanent solution to an inflammation problem.  If inflammation is like a fire, then cortisone is the water to put the fire out.  Sometimes the fire, or inflammation, is completely eliminated by the cortisone.  Sometimes, though, inflammation remains, and can flare back up.  For some people, the cortisone shot doesn't put out the fire completely and they have pain and inflammation come back.  And for some people, the injection doesn't work at all.

Doesn't cortisone damage the tendons and ligaments in my shoulder?  There may be a very small effect on the tendons in the shoulder.  However, a single injection is absolutely safe and causes no weakening.  With multiple injections, however, there is a risk of weakening tendons in the joint.  If multiple injections might be necessary, then you should know about this small but real risk.

Are there any other side effects of cortisone?  In patients with diabetes, cortisone may cause a temporary increase in blood sugars.  This effect wears off after a week or so.  There is a small increased risk of infection after a cortisone shot, because the shot decreases the body's ability to fight infection. 

How is the injection given?  In my practice, I use a small ultrasound machine to guide the injection into the correct location.  Here is a video of a cortisone injection:

Comments

Anonymous said…
I have had three doses of steriod shots by Dr. Frisella over the last year and a half for a torn rotator cuff. Have had minimal pain over the last 6 months!
Unknown said…
Thanks for your information....I have been suffering for shoulder pain last 1 year. I hope, this will help me.Pharmacology
Valerie said…
I really appreciate your effort of sharing this information, it's really helpful. But I guess I'll just stick to taking joint support supplements since mine is not that severe.
Unknown said…
Thank you Doctor Frisella for this article:

I have had two cortisone shots in my knee. I was wondering if the threat of tendon weakening is correlated to the number of injections or to the duration? For instance, would it be riskier to have two injections within 3-months, or three injections within 3-years? Thank you.
Dean, it's definitely better to have the injections spread out than close together. It depends on how old you are, but patients younger than 50 should really try to minimize injections to every 6 months or so at the most, and to minimize the total number of lifetime injections. For patients older than 60, every 3 months is probably reasonable, but again the focus should be on minimizing the number. If you're needing injections more often, it might be reasonable to consider surgery.
Unknown said…
What is the rationale for no more than 2 within 6 months? I'm 38, have had shoulder pain (bursitis and tendonitis) since September. Cortisone shot in Han seemed to be working and I was gradually returning to arm exercises (no over the shoulder, but light trx, light weights, planks/push-ups). Then it seemed that doing mountain climber as part of training circuit set it off and I've had intense pain shooting down my arm since last week. I've done no arms since last wed and no activity at all for 4 days and not improving. My doctor is hesitant to give another shot but pt did not work last time-
Anonymous said…
Hello, What is the next step for a shoulder in which a cortisone shot does not work? I have spent 3 months in PT with little relief for shoulder pain since this shot. Doc says its tendonitis but mri shows multiple small partial tears of rotator cuff, Doc said they were small so they don't count. I am so lost and confused. Living in agony. Any suggestions would be great. Thanks
Melissa
For a patient who has had therapy and injection, it is appropriate to consider arthroscopy to debride (or clean up) small tears, look to see if the tears might be larger than they appear ont he MRI, and to remove bone spurs under the acromion that might be rubbing or causing impingement. Another cortisone shot might also be a good idea before proceeding to surgery; it's possible that a second shot would help when the first didn't. Good luck!
Anonymous said…
I had a shoulder injection last week & I'm in more pain than before. Is it ok to get an other one this coming Tues?
Plantar said…
I'm suffering from plantar fasciatis and have seen a GP. It ' been extremely painful and since I have to walk a lot, to drop & pick daughter from school , work and groceries ( I don't drive yet) I find it extremely painful and annoying to have this problem. I have seen a local GP who prescribed me steroid injection and I was told at imaging centre that it is safe as it is given in as all amounts. I took them on both my feet , my right one had more pain than my left one. My right legs pain did nt fade even I felt after the injection pain started to be there all day instead of just n the morning . I could not bare the pain I asked for another shot on my right , within two weeks time I had not done much research , now I'm extremely panicking as to whether I have damaged my tendons by doing thus in such a short time. I'm only 30 and now extremely worried. Pls guide me
Don't worry, it's completely safe to get a few injections to try and address plantar fasciitis. Plantar fasciitis is similar to rotator cuff tendonitis, and it is not unheard of to get a few injections close together. I would recommend against getting any more in the next 6 months, though. You should also consider physical therapy and nighttime splints to address your problem. Just know it will get better with time!
Believe said…
Hi,

I have had pain in my shoulder and upper arm for 3 months. Receeived a Cortisone injection into rotary cuff on Wednesday and it is worse today. I hollered in pain. Now using ice on it. How long do I have to wait before shoulder surgery?
Unknown said…
Hello, I've been dealing with pain in my shoulder for awhile now. I had surgery Nov. 2nd 2015 for a slap repair and open bicep tendonesis I had to get 3 anchors and a "screw" put in my arm recovery was awesome I was lifting my shoulder above my head with no problem 2 weeks after the surgery I had doctors stumped but there was a few personal things that happened to where now I can't move my arm to the side and up above my head I'm 27 years old and my pt stated their red flagging me for a rotator cuff injury do you think a cortisone shot would help? Mind you I've been doing pt since end of April 2015
Anonymous said…
can you have two injections at the same time on the shoulder?