Cortisone shot side effects
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Injectible cortisone is a synthetic product and has many different trade names (e.g. Depo-medrol, Aristospan, Celestone, Kenalog, etc.), but is chemically similar to the body's natural product.
Cortisone is a powerful anti-inflammatory medication.
Conditions for which cortisone shots are given include bursitis, arthritis, tendonitis, trigger finger, tender trigger points, carpal tunnel syndrome and other entrapment neuropathies.
The shot may be painful, but in the hands of a skilled rheumatologist using ultrasound guidance, it usually is well tolerated. Often the cortisone injection can be performed with a small needle that causes little discomfort. Sometimes though, a slightly larger needle must be used, especially if the physician is attempting to remove fluid from a joint prior to injecting the cortisone. Numbing medication, such as lidocaine or bupivicaine, is often injected with the cortisone to provide temporary relief of the affected area. I like to “numb” the area first with a small injection of lidocaine.
The most common side-effect is a ”steroid flare”. This is a condition where the injected cortisone crystalizes and can cause a brief period of pain worse than before the shot. This usually lasts a day or so and is best treated by icing the injected area. Another common side-effect is discoloration of the skin where the injection is given. This is usually a concern in people with darker skin, and is not harmful, but patients should be aware of this. Atrophy of the skin and thinning of the skin may also occur at the site of injection.
A potentially serious side-effect of cortisone injection, though rare, is infection. The best prevention is careful injection technique, with sterilization of the skin using iodine and alcohol or chlorhexidine.
Patients with diabetes may have a brief period of increase in their blood sugar which they should watch for closely.
By the same token, patients with blood pressure problems may have temporary aggravation of their hypertension.
Another possible side effect is inadvertent injection of the steroid preparation into the blood stream. Careful technique by the physician should prevent this from happening.
Tendon rupture can occur if the steroid is injected directly into a weakened or in flamed tendon.
Another side effect is not having the injection work because it wasn’t injected into the right area. This problem can be avoided by making sure of the skill of the physician.
True allergic reactions are rare. However, it is possible to be allergic to Betadine many physicians use to sterilize the skin.
Cortisone injection should not be given more than three times a year into the same area. Too many steroid injections can cause thinning of the skin, thinning of cartilage, and weakening of tendons. A serious side effect from too much cortisone is avascular necrosis of bone. This is a condition where the bone dies. It is most common in the hip, shoulder and knee. Multiple steroid injections can theoretically suppress the adrenal glands and lead to shock. Finally, if steroid injection doesn’t work, it shouldn’t be repeated.
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