Steroid Injections

What It Is

A steroid injection, also called a cortisone shot, is a small injection of a corticosteroid (a strong anti-inflammatory medicine), usually mixed with a numbing medicine like lidocaine, placed directly into an inflamed joint, bursa, or tendon. The corticosteroid calms the inflammation for weeks to months; the numbing medicine gives short-term relief and helps confirm the right spot was treated.

This is the most commonly used non-surgical treatment in orthopedics and has been in use, in essentially its current form, since the 1950s.

What a Steroid Injection Is Not

The word "steroid" causes a lot of confusion. A corticosteroid is not the same as several other things people mix it up with:

• Not muscle-building (anabolic) steroids. A corticosteroid reduces inflammation. It is not the anabolic steroid used to build muscle, and it does not have those effects.
• Not a gel or lubricating shot. Hyaluronic acid injections (also called gel injections, viscosupplementation, or a "rooster comb shot") add lubrication to a joint. That is a different medicine for a different purpose. See gel injections.
• Not a biologic or healing injection. Platelet-rich plasma (PRP) and bone marrow concentrate (BMAC) use your own blood or marrow to try to promote healing. A corticosteroid does the opposite job: it quiets inflammation. See PRP.
• Not a nerve block. A nerve block targets a specific nerve to interrupt pain signals. A steroid injection treats inflammation at a joint, bursa, or tendon.
• Not a spinal (epidural) injection. Steroid injections into the spine for back or neck pain are interventional procedures performed by a pain management specialist, not here. OSI provides joint and soft-tissue injections in the arms and legs; for spinal injection treatment, OSI directs you to the right specialist.

How It Works

Cortisone is a strong anti-inflammatory medicine. When injected directly into an inflamed area, it quiets down swelling and pain at the source. It does not reverse arthritis, regrow cartilage, or repair a torn tendon, it simply turns down the inflammation around the problem so you can move and feel better.

Conditions We Commonly Use It For

What to Expect

• The shot itself takes a few minutes. Some joints go in by feel; deeper ones (hip, occasional shoulder) use ultrasound or X-ray guidance for accuracy.
• A small group of patients (about 1 in 20) get a brief “steroid flare”, increased pain for 24 to 48 hours. Ice and an over-the-counter anti-inflammatory usually settle it.
• Relief usually starts a few days after the injection and peaks a short while later.
• How long it lasts varies widely, weeks to several months. Some patients get long, durable relief; others need a repeat down the road.

Risks and Limitations

• It is temporary. Cortisone calms inflammation; it does not cure the underlying problem.
• How often we will do it. We space repeat injections in the same joint and avoid repeat shots directly around weight-bearing tendons, your surgeon will determine the right cadence.
• Blood sugar. If you have diabetes, expect a short rise in blood sugar for the first stretch after the shot.
• Skin changes. A small chance of lightening of the skin or thinning of the fat at the injection site, especially with shots that are close to the skin.
• Infection. Very rare (less than 1 in 10,000) when done with sterile technique.
• Tendon concerns. Repeated shots right next to a weight-bearing tendon (Achilles, patellar) can weaken it, so we generally avoid those.
• Cartilage. Long-term studies show repeated cortisone in an arthritic knee over many years may contribute to a small extra amount of cartilage loss, so we tailor how often we repeat it.