Disease: Cortisone Injection (Corticosteroid Injection) of Soft Tissues and Joints

    Corticosteroid (cortisone) injection of joints and soft tissue facts

    • Corticosteroids are powerful anti-inflammatory medications.
    • Cortisone injections can offer fast-acting relief of inflamed joints, tendons, and bursa.
    • Complications are rare but may include infection and bleeding.
    • When administered by an expert, cortisone injections offer significant pain relief with only minimal discomfort.

    What are corticosteroids?

    Corticosteroids are a class of medications that are related to cortisone, a steroid. Medications of this class powerfully reduce inflammation. They are used to reduce the inflammation caused by a variety of diseases. Cortisone is one type of corticosteroid. For the purpose of this review, "cortisone" is used interchangeably with "corticosteroid."

    Corticosteroids can be taken by mouth, inhaled, applied to the skin, given intravenously (into a vein), or injected into the tissues of the body. Examples of corticosteroids include prednisone and prednisolone (given by mouth), methylprednisolone sodium succinate injection (Solu-Medrol) (given intravenously), as well as triamcinolone (Kenalog), betamethasone (Celestone), methylprednisolone (Depo-Medrol), and others (given by injection into body tissues). This article describes the role of cortisone injections into the soft tissues and joints.

    Is a cortisone injection merely a pain reliever or temporary remedy?

    Corticosteroids are not pain relievers. They reduce inflammation. When corticosteroids relieve pain, it is because they have reduced inflammation.

    While the inflammation for which corticosteroids are given can recur, corticosteroid injections can provide months to years of relief when used properly. These injections also can cure diseases (permanently resolve them) when the problem is tissue inflammation localized to a small area, such as bursitis and tendonitis. They can also cure certain forms of skin inflammation.

    For what conditions are cortisone injections used?

    Cortisone injections can be used to treat the inflammation of small areas of the body (local injections), or they can be used to treat inflammation that is widespread throughout the body (systemic injections). Examples of conditions for which local cortisone injections are used include inflammation of a bursa (bursitis of the hip, knee, elbow, or shoulder), a tendon (tendinitis such as tennis elbow), and a joint (arthritis). Knee osteoarthritis, hip bursitis, painful foot conditions such as plantar fasciitis, rotator cuff tendinitis, and many other conditions may be treated with cortisone injections. Injections of cortisone and an anesthetic such as lidocaine are sometimes used to confirm a diagnosis. For example, if pain in the buttock and groin improves after a cortisone injection in the hip, the pain is caused by hip arthritis rather than arthritis in the low back. Epidural injections in the lumbar spine (lumbar epidural) are cortisone injections inserted into a specific location in the spinal canal of the low back by a specialist under X-ray guidance (fluoroscopy). These injections may help relieve neck pain, back pain, or sciatica. Systemic corticosteroid injections are used for more widespread conditions affecting many joints or the skin, such as allergic reactions, asthma, and rheumatoid arthritis.

    What are the advantages of cortisone injections?

    When a joint is swollen, joint fluid may be removed before cortisone is injected. If fluid is removed, it can be analyzed with laboratory testing to determine what caused the joint to swell. This is a big advantage as it is a powerful and accurate diagnostic test.

    A distinct benefit of a corticosteroid injection is that the relief of localized inflammation in a particular body area is more rapid and powerful than with traditional anti-inflammatory medications given by mouth, such as aspirin. A single injection also can avoid certain side effects that can accompany many oral anti-inflammatory medications, notably irritation of the stomach. Cortisone injections can be administered easily in the doctor's office. Other advantages include the rapid onset of the medication's action, dependability, and minimal side effects.

    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 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.

    Are there special advantages in using cortisone injections for joint inflammation (arthritis)?

    Cortisone injections into a joint can be beneficial in rapidly reducing joint pain while restoring function to a body part immobilized by inflammation, such as an arthritic knee or elbow. This might be particularly important in certain circumstances, such as the gainful employment of a family breadwinner or someone who lives alone. Despite potential and infrequently reported adverse reactions as described above, it is generally felt that low, intermittent doses of corticosteroids pose little risk of significant side effects.

    Cortisone injections into a joint also can decrease the inflammation in diseased joints throughout the body when the corticosteroids are absorbed from the joint into the circulation.

    How are cortisone injections of soft tissues given?

    The medical professional administering the injection draws up the corticosteroid into a syringe. A local anesthetic (such as lidocaine) may simultaneously be drawn into the syringe. Next, the area to be injected is selected. Typically, the skin over the area to be injected is sterilized with a liquid solution, either alcohol or Betadine.

    Sometimes, the area is topically anesthetized by rapid cooling using a spray such as ethyl chloride. The needle of the syringe then is inserted into the tissue to be injected and the solution is ejected from the syringe into the area of inflammation. The needle then is withdrawn, and a sterile bandage is applied to the injection site.

    Is a cortisone injection merely a pain reliever or temporary remedy?

    Corticosteroids are not pain relievers. They reduce inflammation. When corticosteroids relieve pain, it is because they have reduced inflammation.

    While the inflammation for which corticosteroids are given can recur, corticosteroid injections can provide months to years of relief when used properly. These injections also can cure diseases (permanently resolve them) when the problem is tissue inflammation localized to a small area, such as bursitis and tendonitis. They can also cure certain forms of skin inflammation.

    For what conditions are cortisone injections used?

    Cortisone injections can be used to treat the inflammation of small areas of the body (local injections), or they can be used to treat inflammation that is widespread throughout the body (systemic injections). Examples of conditions for which local cortisone injections are used include inflammation of a bursa (bursitis of the hip, knee, elbow, or shoulder), a tendon (tendinitis such as tennis elbow), and a joint (arthritis). Knee osteoarthritis, hip bursitis, painful foot conditions such as plantar fasciitis, rotator cuff tendinitis, and many other conditions may be treated with cortisone injections. Injections of cortisone and an anesthetic such as lidocaine are sometimes used to confirm a diagnosis. For example, if pain in the buttock and groin improves after a cortisone injection in the hip, the pain is caused by hip arthritis rather than arthritis in the low back. Epidural injections in the lumbar spine (lumbar epidural) are cortisone injections inserted into a specific location in the spinal canal of the low back by a specialist under X-ray guidance (fluoroscopy). These injections may help relieve neck pain, back pain, or sciatica. Systemic corticosteroid injections are used for more widespread conditions affecting many joints or the skin, such as allergic reactions, asthma, and rheumatoid arthritis.

    What are the advantages of cortisone injections?

    When a joint is swollen, joint fluid may be removed before cortisone is injected. If fluid is removed, it can be analyzed with laboratory testing to determine what caused the joint to swell. This is a big advantage as it is a powerful and accurate diagnostic test.

    A distinct benefit of a corticosteroid injection is that the relief of localized inflammation in a particular body area is more rapid and powerful than with traditional anti-inflammatory medications given by mouth, such as aspirin. A single injection also can avoid certain side effects that can accompany many oral anti-inflammatory medications, notably irritation of the stomach. Cortisone injections can be administered easily in the doctor's office. Other advantages include the rapid onset of the medication's action, dependability, and minimal side effects.

    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 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.

    Are there special advantages in using cortisone injections for joint inflammation (arthritis)?

    Cortisone injections into a joint can be beneficial in rapidly reducing joint pain while restoring function to a body part immobilized by inflammation, such as an arthritic knee or elbow. This might be particularly important in certain circumstances, such as the gainful employment of a family breadwinner or someone who lives alone. Despite potential and infrequently reported adverse reactions as described above, it is generally felt that low, intermittent doses of corticosteroids pose little risk of significant side effects.

    Cortisone injections into a joint also can decrease the inflammation in diseased joints throughout the body when the corticosteroids are absorbed from the joint into the circulation.

    How are cortisone injections of soft tissues given?

    The medical professional administering the injection draws up the corticosteroid into a syringe. A local anesthetic (such as lidocaine) may simultaneously be drawn into the syringe. Next, the area to be injected is selected. Typically, the skin over the area to be injected is sterilized with a liquid solution, either alcohol or Betadine.

    Sometimes, the area is topically anesthetized by rapid cooling using a spray such as ethyl chloride. The needle of the syringe then is inserted into the tissue to be injected and the solution is ejected from the syringe into the area of inflammation. The needle then is withdrawn, and a sterile bandage is applied to the injection site.

    Source: http://www.rxlist.com

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