Should you get that cortisone shot or not?

Should you get that cortisone shot or not?

Cortisone shots – likely you know a friend or family member who has had one.  They can be an invaluable next step when pain relievers or physical therapy are no long effective at reducing pain and inflammation from musculoskeletal conditions.

Often called ‘steroids’ for short, corticosteroids or cortisone, are synthetic drugs that closely resemble cortisol, a hormone your adrenal glands produce naturally.  However, corticosteroids are not the same thing as the male hormone-related steroid compounds (anabolic steroids) sometimes used by athletes.  Corticosteroids work by reducing inflammation and are used to treat a variety of inflammatory diseases and conditions.  These conditions can include osteoarthritis, bursitis, tendinitis, or carpal tunnel syndrome as examples.

Overview on cortisone shots

A cortisone injection may help relieve pain and inflammation in a specific area of the body.  They are commonly injected directly into a joint such as the ankle, elbow, hip, knee, shoulder, spine, and the wrist.  The injections are usually comprised of a corticosteroid medication and a local anesthetic and are generally given as an outpatient during a doctor’s visit.

The decision for a steroid shot is based on an individual’s need.  Factors such as the patient’s age, level of physical activity, disease conditions, and medications they are taking will be considered and evaluated by a doctor before recommending these shots.

What to expect when given a steroid shot

The injection site will be cleaned followed by an anesthetic spray to numb the area where the needle will be inserted.  Depending on the location, your doctor may use an ultrasound or fluoroscopy to view the needle’s direction into your body in order to inject it into the right location.

As the needle is inserted, pressure will be felt but there should be minimal discomfort.  After the shot is given, some people may have redness and a feeling of warmth across their chest or face from the cortisone shot. 

Potential advantages of steroid shots

The goal of giving a steroid shot is to bring relief from inflammation and pain in a joint.  For many people these injections do result in a significant reduction in discomfort helping a person to be able to continue with regular activities with more ease, free from pain.  Steroid injections may also help avoid the need for oral steroids or increased doses of oral steroids which can have greater side effects.

Cortisone shots can be extremely helpful in alleviating pain for patients suffering from a range of conditions, including:

·      Knee and hip arthritis

·      Lupus and other autoimmune disorders

·      Rheumatoid arthritis

·      Foot problems such as plantar fasciitis

·      Back pain from vertebrae that have slipped out of place

·      Bursitis or tendinitis

·      Asthma

Potential disadvantages of steroid shots

Like with any medical procedure of injecting a substance into the body, there can be downsides. 

One downside is that steroid shots should not be given if the area is already infected or if the joint is severely destroyed as the injection would not provide any benefit.  Anyone on anticoagulants or blood thinners or anyone with a potential bleeding disorder may not be candidates for these injections.

It is highly recommended that steroid shots not be given any more frequently than every three or four months.  The reason repeated cortisone injections are discouraged is that it can begin to cause damage to tissues over time. If injections are given more frequently into the same area, it can begin to cause weakness within the bone, ligaments and tendons surrounding that area.

 However, if a patient with severe knee arthritis is receiving a steroid shot every six months that is helping them significantly, then the number of shots probably does not matter that much. 

But if a patient has a healthy shoulder with shoulder tendonitis, the number of injections should be limited to prevent further damage to these tendons.  There are studies that have shown people receiving regular injections can over time, develop long-term damage to their joints. 

One area that many orthopedic surgeons recommend against injecting a steroid shot is around the Achilles tendon for the treatment of Achilles tendinitis.  Steroid shots in this area of the body have been known to increase the possibility of Achilles tendon rupture. 

In rare cases there can be side effects of infection, allergic reactions, local bleeding, rupture of a tendon, or skin discoloration.  In persons with diabetes, steroid or cortisone shots can elevate the blood sugar.  In these situations, they will need to carefully monitor their blood sugar for the first few days after the injection.  Cortisone injections can also suppress somewhat the body’s ability to fight an infection, possibly worsening an infection or masking it by suppressing the symptoms and signs of inflammation. 

Other possible side effects according to the National Institutes of Health include:

·      Mood swings

·      Increased appetite, weight gain, and water retention

·      Dizziness or headaches

·      Skin issues such as dryness, thinness, acne, dry skin, and red or purple bloches

·      Fatigue and trouble sleeping

More serious issues could include vision problems, difficulty breathing or swallowing, seizures, swelling in various areas of the body, and rash, hives and itching.

Anyone considering getting a steroid shot should thoroughly discuss with their doctor of the risks and benefits they can expect and to make a careful decision if these injections are right for them.