Cortisone Injections

Overview of Cortisone Injections

For many years, cortisone injections have been part of the standard of care for inflammation around tissue injuries, such as nerves, tendons, and ligaments. The goal of cortisone injections is to reduce inflammation, allowing the body to heal the pain as best as possible.

Cortisone is a man-made version of a hormone that occurs naturally in our body called cortisol. While cortisone is part of a large class of medications called steroids, it is not an anabolic steroid and will not have any of the potential effects of anabolic steroids.  When cortisone is placed near an area of severe inflammation, the therapeutic effects related to pain relief can occur in a very short period, instead of waiting for medications or time to allow the resolution of symptoms.

When a patient has pain and severe stiffness from either a frozen shoulder or arthritis that stops them from doing physical therapy, a corticosteroid injection into the glenohumeral joint is strongly recommended. It is often suggested—along with physical therapy—on the very first visit as it accelerates the recovery process with no side effects. Pain that occurs from inflammation of this tissues around the rotator cuff can also be treated with a cortisone injection in the space immediately above the rotator cuff tendon.

Cortisone Injection FAQ

What are the risks of cortisone injections?

In general, injections with cortisone are safe.  The key to a successful injection with minimal side effects is placing the medication in the correct location.  After thousands of arthroscopic surgeries, Dr. Romeo is able to do this routinely with no additional supportive devices such as ultrasound guidance, which add to the overall cost of the treatment.  After the injection, he confirms with the patient that the area that was causing symptoms has been resolved with the local anesthetic that is placed with the cortisone.  However, if there is any concern over placing the medications in the correct location, ultrasound guidance may be helpful.

Cortisone shots have been associated with a local hyperreaction which causes a short term increase in pain, potential degradation of the local tissues due to treatment of inflammation which is a normal part of the healing process, increased risk of elevated glucose levels in diabetics, and increased risk of infection, especially if surgery is performed relatively soon after the injection.  For most patients, the frustrating aspect of these injections is that they often provide incomplete symptom relief and the duration of effectiveness is weeks to months. Because of this, numerous other treatment modalities are combined with cortisone injections or used instead of an injection.

Are there other kinds of injections available?

Yes, there has been a recent increase in the types of medicines or biologically active solutions that are offered to treat musculoskeletal conditions.  Recently, a new cortisone medication has been developed that has the potential to last much longer than standard cortisone and is FDA approved for the knee.  Some physicians have used it for the shoulder, however the patient must pay for the medication. 

A new group of injectable substances which are mostly derived from the patient’s own body and then injected at the site of injury or inflammation are referred to orthobiologics.  These substances, which may include platelet rich plasma (PRP) or stems cells from fat or bursa have the potential to improve the healing response.  Sometimes these treatments are referred to regenerative medicine which may imply that injured or absent tissues are being regenerated. However, for the most part, the evidence suggests that relief of pain from inflammation is actually the key treatment outcome.  Remarkably, at least in the knee, there is evidence that this inflammation relief lasts much longer with PRP that it does with cortisone.

Dr. Romeo offers PRP injections for a variety of shoulder and elbow conditions, including tendonitis, partial tendon tears, and arthritis.  However, insurance companies do not pay for these injections, so the patient is financially responsible for the process and equipment necessary for harvesting and injecting PRP.

What do patients with diabetes need to know about cortisone injections? 

Patients with diabetes need to carefully monitor their blood sugar for 48 hours after a cortisone injection. A cortisone injection can cause a blood sugar spike requiring a temporary adjustment in their insulin therapy or medications. Even glucose intolerant patients need to be careful and monitor their blood surgery for up to 48 hours after a cortisone injection. 

For more information about the risks and benefits of cortisone injections for your condition, please request an appointment with experienced Chicago orthopaedic surgeon Dr. Anthony Romeo. Call our office today to schedule your visit.

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