Cortisone Injections – Patient Information



CORTISONE INJECTIONS - PATIENT INFORMATION

Cortisone is commonly used in the treatment of musculoskeletal disorders to suppress inflammation and/or reduce tissue swelling. Cortisone is a naturally occurring steroid hormone produced by the body.

Why inject cortisone?

• To reduce or eliminate pain and swelling associated with a variety of disorders (e.g. tendinopathy, bursitis and/or arthritis). Although cortisone injections can be very helpful in relieving pain, they generally form only one part of your doctor’s overall treatment plan.

• Help to increase mobility.

• Often, as pain settles, other medications can be reduced.

• To confirm or exclude a specific diagnosis. The precise cause of pain can sometimes be difficult to determine. In this situation, an injection into a specific anatomical space can help to confirm or exclude a diagnosis.

Are there alternatives?

Other treatment options do exist, and they will be discussed with you during the clinical consultation. Cortisone injections are optional procedures that carry no guarantees of success and no untoward consequences if declined. There is no penalty for changing your mind prior to the scheduled injection.

What are the likely benefits of injection?

Although the exact level of response cannot be reliably predicted prior to injection, some degree of pain relief occurs in about 70% of cases. For some, this relief is dramatic and long lasting, while for others the benefit is only modest or short-lived, and for a minority there is no benefit at all.

What is involved?

The skin over the area of injection is first cleaned with an antiseptic agent. The injection is then performed by Dr G Singh using a disposable sterile needle and syringe. During some joint injections, image guidance is used to ensure accurate needle tip placement. The degree of discomfort or pain experienced during the injection is generally only mild, as the needle used is relatively thin and a local anaesthetic agent is mixed with the cortisone. However, a greater level of injection discomfort may occur if the underlying inflammation is severe, or a bad experience in the past has resulted in a fear of needles. Some injections require the needle tip to be re-positioned several times, e.g. calcium aspiration from a shoulder tendon, but in these cases additional local anaesthetic is used.

Are there any risks or side effects?

There are risks and side-effects with any form of drug treatment, but significant complications with cortisone injections are rare.

The most common side-effect is an increase in pain at the injection site before the cortisone takes effect, and this can sometimes be severe. These “flares” do not occur in all patients and mostly happen in the first four to 48 hours after injection. Treatment involves simple analgesic measures (e.g. Panadol, cold-packs).

Occasionally, patients can develop a red face and feel flushed. This usually develops on days 2 to 3 and can last up to seven days. It is not usually serious but in some people it is accompanied by flu-like symptoms; however, a raised temperature should not occur. This usually clears spontaneously. Antihistamines may relieve the symptoms.

Insulin-dependent diabetic patients may notice a moderate rise in blood sugar for up to 10 days after the injection. If you increase your dose of insulin, be careful not to create a hypo-glycaemic episode when the circulating sugar levels revert to normal. Please consult your diabetic/managing doctor if concerned.

Infection is a rare but a potentially serious complication. If you experience fever, localised heat, swelling or increasing pain at the injection site more than 48 hours after injection, you should consult your doctor or attend the Emergency Department of your local hospital without delay. If any doubt remains, antibiotic treatment will be given.

Cortisone injected directly into a tendon has been reported to weaken and damage the fibres, and thus carries a risk of delayed tendon rupture.

All other risks are either very uncommon or rare, but risk do include allergy (to either the antiseptic agents or the injected drugs), and localized bruising. Superficial injections carry a risk of localized skin and subcutaneous fat atrophy (dimpling), and rarely hypopigmentation (white skin) at the injection site.

AVN (avascular necrosis), a condition leading to bony collapse of the femoral or humeral heads, is a recognised hazard of prolonged high-dose (usually oral) steroid therapy, but has not been documented with isolated injections of cortisone. Isolated injections of cortisone do not cause osteoporosis or any alteration in facial appearance or weight.

What to expect afterwards

When the anaesthetic wears off you may experience aching at the injection site.

You may experience pain for 48 hours.

Cortisone takes approximately 36 hours to start working, but it may take longer or shorter.

If you are concerned that you are having untoward after-effects from your injection, please ring your doctor or attend your local emergency department in the event it is after hours.

Reception staff from MSM Pain Clinic will contact you within 24 to 48 hours after the injection to check upon your condition and to arrange a follow-up appointment with Dr G Singh.

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