Cortisone Injection (cont.)
Catherine Burt Driver, MD
Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- Corticosteroid (cortisone) injection of joints and soft tissue facts
- What are corticosteroids?
- Is a cortisone injection merely a pain reliever or temporary remedy?
- For what conditions are cortisone injections used?
- What are the advantages of cortisone injections?
- What are the disadvantages and side effects of cortisone injections?
- Are there special side effects that can occur with cortisone joint injections?
- Are there special advantages in using cortisone injections for joint inflammation (arthritis)?
- How are cortisone injections of soft tissues given?
- How are cortisone injections of a joint given?
- Are cortisone injections painful?
What are the disadvantages and side effects of cortisone injections?
Disadvantages of cortisone injections are the necessity of piercing the skin with a needle as well as potential short- and long-term side effects. It should be emphasized that though each of these side effects is possible, they usually do not occur.
Short-term cortisone injections complications are uncommon but include
- shrinkage (atrophy) and lightening of the color (depigmentation) of the skin at the injection site, introduction of bacterial infection into the body (such as a joint infection), local bleeding from broken blood vessels in the skin or muscle,
- soreness at the injection site, and
- aggravation of inflammation in the area injected because of reactions to the corticosteroid medication (postinjection flare).
Increased pain after the injection is typically due to a postinjection flare because true allergies to cortisone are very rare. Tendons can be weakened by corticosteroid injections administered in or near tendons. Tendon ruptures as a result have been reported. Facial flushing may occur in up to 40% of cases but lasts only briefly. Sweating and insomnia are uncommon side effects. Nerve damage is a very uncommon side effect.
In people who have diabetes, cortisone injections can elevate the blood sugar. In patients with underlying infections, cortisone injections can suppress somewhat the body's ability to fight the infection and possibly worsen the infection or may mask the infection by suppressing the symptoms and signs of inflammation. Generally, cortisone injections are used with caution in people with diabetes and avoided in people with active infections. Cortisone injections are also used cautiously in people with a bleeding disorder.
Long-term complications of corticosteroid injections depend on the dose and frequency of the injections. With higher doses and frequent administration, potential side effects include
- thinning of the skin,
- easy bruising, weight gain,
- puffiness of the face,
- acne (steroid acne),
- elevation of blood pressure,
- cataract formation,
- thinning of the bones (osteoporosis), and
- a rare but serious type of damage to the bones of the large joints (avascular necrosis or osteonecrosis).
Are there special side effects that can occur with cortisone joint injections?
Cortisone injections into a joint may have side effects in addition to those described above. Unique side effects of joint injections involve injury to the joint tissues, particularly with repeated injections. These injuries include thinning of the joint cartilage, weakening of the ligaments of the joint, increased inflammation in the joint (arthritis) due to a reaction to a corticosteroid that has crystallized, and introduction of infection into the joint.
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