Cortisone injections are one of the most common orthopedic treatments offered to patients today. When you go to see a doctor for a musculoskeletal injury, that doctor typically has 4 options to offer you: surgery, physical therapy, medication, or injection. When it comes to injections, cortisone is far and away the most common one received. But what is cortisone exactly? What can it help you with? Can it be harmful to you? Are there certain issues it helps with more than others? This article will take a deep dive into what cortisone injections do and when you should consider when

What is a Cortisone Injection?

Cortisone injections are short for the term corticosteroids. This class of steroids mimics the effects of cortisol which is a naturally occurring hormone produced in the adrenal glands of our body. Corticosteroids help reduce inflammation in an area. They do this by reducing the levels of prostaglandins in the area as well as reducing the interaction between certain white blood cells that are involved in the immune response. These injections are typically given directly into a joint like the shoulder, hip, or knee; or they are given in soft tissue structures such as tendons or bursa. They are given to reduce inflammation & reducing pain.

 

READ: THE TRUTH ABOUT ICING INJURIES

 

So cortisone shots are primarily used to treat inflammation. While you may read a lot about the negative effects of chronic inflammation or the importance of getting the inflammation down after an injury, inflammation is an important & natural bodily response that helps our body heal after an injury or infection. In short, we don’t want to throw cortisone at every single inflammatory response our body has, because most often we NEED that inflammatory response to heal. However, there are times when our body has a pathological type of inflammation that is not helping our body heal or when inflammation lingers long after it has served its purpose, these are the situation in which cortisone is most helpful.

 

What is a Cortisone Injection Good for?

Cortisone decreases inflammation & provides short-term pain relief. It does not help heal any tissues. With this in mind, there are several diagnoses that it is particularly helpful. These often include those that arise from an inflammatory issue (1).

 

Frozen Shoulder or Adhesive Capsulitis: is an inflammatory condition characterized by shoulder stiffness, pain, and significant loss of passive range of motion (2). While the exact cause is unknown we know that this type of inflammation is not needed to heal the body, but does eventually heal on its own with a typical restoration of full range of motion and function in the vast majority of patients. Check out the below video to learn more about Frozen Shoulder and the exercises you can do.

 

 

Cortisone injections directly into the shoulder joint are helpful in relieving pain & improving range of motion in the short & medium term (2-4 months) as well as potentially reducing the likelihood of this turning into a chronic issue (3). 

 

Trigger Finger: is a condition affecting the tendons that flex the fingers and thumb, typically resulting in a sensation of locking or catching when you bend and straighten your fingers. It is caused by inflammation of the tendon inside their sheath which prevents smooth movement. A cortisone injection directly into the tendon sheath is a very successful first-line treatment for these patients often curing the issue in up to 86% of cases (4).

 

Carpal Tunnel Syndrome: is a common disorder that occurs when the median nerve, which runs from your forearm into the palm becomes compressed at the wrist. It leads to numbness, weakness, pain & decreased strength in the muscles of your hand and fingers. In short, inflammation decreases the space available for your nerve, thus compressing it. Cortisone injections led to short-term improvement at 2-3 months and have been shown to decrease the need for surgery in this population at 1 year post injection (6).

 

What MIGHT Cortisone Injections Help With?

Cortisone injections can help provide a window of pain relief to allow you to address a problem that is currently too painful to address. Most often, when you need to strengthen the muscles around an area but are in too much pain to do so, cortisone can potentially temporarily reduce that pain allowing you to build up your strength & function for more lasting results.

 

 

Greater Trochanteric Pain Syndrome: is a diagnosis formerly referred to as Greater Trochanteric Bursitis due to the belief that it resulted from an excessive inflammation of the bursa (7). It is now believed that this issue is more likely due to tendinopathy of the gluteal medius and/or minimus (the tendons of the outside of your hip) due to abnormal biomechanics. Since it has been historically thought of as an inflammation, many patients received cortisone injections for this diagnosis.

However, the evidence shows that cortisone injections simply provide greater pain relief at 6 weeks & 3 months, but no difference in pain or function at 6 months or one year (8). Thus it is believed to only provide a window of pain relief during which patients can strengthen and address the root issues causing their pain.

 

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Osteoarthritis (OA): is a degenerative joint disease that typically results from the wearing away of the articular cartilage in a joint space that serves as the cushion between your bones. Some common areas include the knee & hip. Many patients with hip and knee OA benefit substantially from strength training which can help reduce the stress placed on your joints by everyday activity.

 

READ: EXERCISES FOR HIP OSTEOARTHRITIS

 

In those patients who are in too much pain to strength train, cortisone injections can provide a window of pain relief to allow them to build up their strength as well as their range of motion. In those with knee osteoarthritis, cortisone injections are mostly shown to provide a period of pain relief of just 1-2 weeks, however, some show improvement lasting up to a month (9). In those with hip osteoarthritis, Fluoroscopically guided (moving X-rays to ensure proper placement) corticosteroid injections provide improvement in pain, stiffness, and physical function at two months compared with placebo injections (10.)

 

When combined with strengthening the efficacy of a few months of pain relief can make a big difference for these patients. Check out this video below to learn some exercises to help manage your hip osteoarthritis!

 

 

What are the Risks & Who Won’t Cortisone Injections Help?

Although helpful for reducing pain and inflammation cortisone shots do come with some drawbacks. Most specifically, then can have negative effects on your soft tissue and cartilage, potentially wearing away these structures over time (12). For these reasons, many doctors will not give more than two cortisone injections into the same joint in a year and many have moved away from providing them for soft tissue injuries such as tendinopathies & impingement injuries:

These include:

1. Golfers elbow *psst take a peek at the program below
2. Tennis elbow *psst, seriously, look at the program below
3. Subacromial impingement syndrome
4. Hip labral tears or hip impingement issues

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While a cortisone injection may not serve a role in your rehab from tennis or golfer’s elbow our Elbow, Wrist & Hand Rehab program certainly can and should! This 8-week program will help to decrease your pain and begin to build up your tissue’s strength and endurance! Get started with a free 7-day trial today! 

 

All of these showed no medium to long-term benefits from cortisone injections and included the potential risk for worse long-term outcomes. Specifically for tendinopathies such as tennis elbow, those who received a cortisone injection were more likely to suffer a re-occurrence of symptoms one year later.

 

Closing Thoughts:

Cortisone injections are a helpful tool in addressing orthopedic injuries, but they are not a cure-all and they are not without any downsides. For ailments that are a pathological inflammatory ailments like frozen shoulder and trigger finger, they are a front-line treatment that can work miracles. For joint issues like osteoarthritis, they may be a window of providing pain relief to allow strength training to occur which can produce more lasting success. Soft tissue injuries & tendinopathies are less likely to provide lasting pain and present some serious risks to the integrity of these structures in the long term. For these reasons, they should rarely be given for issues like golfer & tennis elbow as well as impingement-type injuries. Of course, the decision to proceed with an injection is always based on a variety of personal factors that you and your doctor should evaluate together.

 

References:

1. Foster ZJ, Voss TT, Hatch J, Frimodig A. Corticosteroid Injections for Common Musculoskeletal Conditions. Am Fam Physician. 2015;92(8):694-699.
2. St Angelo JM, Taqi M, Fabiano SE. Adhesive Capsulitis. [Updated 2023 Aug 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.
3. Blanchard V, Barr S, Cerisola FL. The effectiveness of corticosteroid injections compared with physiotherapeutic interventions for adhesive capsulitis: a systematic review. Physiotherapy. 2010;96(2):95-107.
4. Lorbach O, Anagnostakos K, Scherf C, et al. Nonoperative management of adhesive capsulitis of the shoulder: oral cortisone application versus intra-articular cortisone injections. J Shoulder Elbow Surg. 2010;19(2):172-179.
5. Sato ES, Gomes Dos Santos JB, et al. Treatment of trigger finger: randomized clinical trial comparing the methods of corticosteroid injection, percutaneous release and open surgery. Rheumatology (Oxford). 2012;51(1):93-99.
6. Peters-Veluthamaningal C, Winters JC, Groenier KH, Meyboom-de Jong B. Randomised controlled trial of local corticosteroid injections for carpal tunnel syndrome in general practice. BMC Fam Pract. 2010;11:54. Published 2010 Jul 29. doi:10.1186/1471-2296-11
7. Speers CJ, Bhogal GS. Greater trochanteric pain syndrome: a review of diagnosis and management in general practice. Br J Gen Pract. 2017;67(663):479-480. doi:10.3399/bjgp17X693041
8. Silva F, Adams T, Feinstein J, Arroyo RA. Trochanteric bursitis: refuting the myth of inflammation. J Clin Rheumatol. 2008;14(2):82-86. doi:10.1097/RHU.0b013e31816b4471
9. Hepper CT, Halvorson JJ, Duncan ST, Gregory AJ, Dunn WR, Spindler KP. The efficacy and duration of intra-articular corticosteroid injection for knee osteoarthritis: a systematic review of level I studies. J Am Acad Orthop Surg. 2009;17(10):638-646. doi:10
10. Lambert RG, Hutchings EJ, Grace MG, Jhangri GS, Conner-Spady B, Maksymowych WP. Steroid injection for osteoarthritis of the hip: a randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2007;56(7):2278-2287. doi:10.1002/art.22739
11. Giovannetti de Sanctis E, Franceschetti E, De Dona F, Palumbo A, Paciotti M, Franceschi F. The Efficacy of Injections for Partial Rotator Cuff Tears: A Systematic Review. J Clin Med. 2020;10(1):51. Published 2020 Dec 25. doi:10.3390/jcm10010051
12. Wernecke C, Braun HJ, Dragoo JL. The Effect of Intra-articular Corticosteroids on Articular Cartilage: A Systematic Review. Orthopaedic Journal of Sports Medicine. 2015;3(5). doi:10.1177/2325967115581163

 

About the Author

Tommy Mandala, PT, DPT, SCS, OCS, CSCS

[P]rehab Writer & Content Creator

Tommy Mandala is a Doctor of Physical Therapy, Board Certified Clinical Specialist in Sports & Orthopedics, and Certified Strength and Conditioning Specialist in New York City. He is the founder of ALL IN ACL, a digital coaching platform dedicated exclusively to helping ACLers return to the life they had before their injury with full confidence in their knee. Prior to that, he worked in the sports clinic at Hospital for Special Surgery, the #1 Orthopedic Hospital in the country. While there, he had the opportunity to hone his skills as an ACL specialist working closely with world renowned surgeons and evaluating patients from all over the world. He completed his sports residency training at the University of Delaware where he had opportunities to work with many of their Division I sports teams as well as the Philadelphia 76’ers NBA G-league affiliate, the Delaware Blue Coats. He also trained at Champion Sports Medicine in Birmingham, Alabama where he had the opportunity to learn from researchers in the American Sports Medicine Institute. Currently, Tommy works exclusively with ACLers through his digital coaching model. While many of these clients are athletes, Tommy works with ACLers of all different abilities helping them to build the strength they need to overcome this unique injury. One of his favorite aspects of his job is taking active clients who have never been a “gym person” before and showing them the amazing things that happen when they learn to strength train.

Disclaimer – The content here is designed for information & education purposes only and is not intended for medical advice.