What are the advantages of cortisone injections?

            Cortisone injections can be administered in the doctor’s office. Some of the time an ultrasound is used to guide the needle for placement to ensure accurate positioning of the injection. Often there is a rapid onset of relief of the symptoms from the local anesthetic that is included in the injection. When this occurs it confirms that the area that was injected is what is causing the symptoms. It is therefore, often used as a diagnostic tool. In addition to being a diagnostic tool it can also be a therapeutic tool. The cortisone medication aids in relief of inflammation. This technique allows a more direct application of the therapeutic effect to the area than oral medications which are dispersed diffusely. They can, and often are used in combination with oral medication such as anti-inflammatories.

What are the disadvantages and side effects of cortisone injections?

Injections obviously require piercing the skin with a needle. A small needle is used as well as topical anesthetics to minimize the discomfort of this injection. There are some additional, POSSIBLE short and long term side effects. Although these may occur, they usually do not.

Short-term side effects:

  • Shrinking (atrophy) and lightening of the skin (depigmentation)
  • Introduction of bacteria into the body
  • Local bleeding
  • Muscle soreness
  • Aggravation of the symptoms from a reaction to the injection (Flare)
  • Decrease in the body’s ability to fight infection

Long-term side effects:

  • Weakening of tendons; ruptures have been reported in the Achilles Tendon
  • Weight gain
  • With HIGHER DOSES and FREQUENCY patients can experience systemic side effects including thinning of the skin, easy bruising, puffiness of the face, elevated blood pressure, cataracts and thinning of the bone (osteoporosis). This is more typical of oral steroids.

These side effects can be minimized by appropriate dosing and intervals. This is why I recommend injections not less than 3 months apart.