Patients who experience shoulder pain, such as from frozen shoulder or rotator cuff injuries, will often need to undergo an active rehabilitation program. As part of this management, cortisone injections can assist in the diagnosis and treatment of these conditions.
Cortisone injections, also known as cortisone shots, have potent anti-inflammatory properties, which means they help to reduce tissue swelling and the following scar formation. Patients can benefit from cortisone injections whether they are in the acute or chronic phase of inflammation, and they are often beneficial for conditions such as acute bursitis, degenerative joint conditions, and inflammatory arthritis.
Some of the most common shoulder conditions which may require cortisone injections as part of a management program include:
- Glenohumeral osteoarthritis
- Acromioclavicular Joint Disease
- Adhesive capsulitis (commonly known as frozen shoulder)
- Rotator cuff disease/tears
- Shoulder impingement/bursitis
It is important that a thorough diagnosis is sought prior to receiving cortisone injections. Your history will be taken into account, a clinical examination performed, X-rays, and potentially an MRI scan undertaken.
Facts and Misconceptions about Cortisone Injections
Pain: Many people are under the impression that cortisone injections are painful, but in fact, this is not the case. Cortisone injections are straightforward to administer and are similar to an immunization needle. A local anaesthetic is often used to numb the injection site, further minimizing discomfort.
Number of injections: There is a common belief that you should only have 3 cortisone injections at the most, but this is not supported by scientific evidence. In general, only 1-3 injections are used in a given area, especially around tendons. If a joint injection provides prolonged relief (e.g., 6 months), then it is perfectly reasonable to repeat these injections on multiple occasions.
After the local anaesthetic wears off, the injection site will ache as any injection would. This usually lasts for a day or so, and then as the cortisone starts to work, the discomfort goes away.
2. TISSUE DAMAGE
Multiple injections in the same area should be avoided because although the cortisone does reduce swelling and provide pain relief, it has also been shown to cause some damage to the tendons and joints after multiple injections in the same spot.
Allergic reactions or side effects to the corticosteroid medication which are injected are rare. Local reactions to the injection are slight and should be limited to local tenderness and perhaps some redness and swelling for the first day. The pain should not be more than that easily relieved with aspirin or Panadol. Report any pain, redness, or swelling in excess of that described above to your doctor immediately. Although extremely rare, infection is possible following a cortisone injection.
4. SKIN COLOUR CHANGES
Injections close to the skin may cause changes in skin colour (either an increase or decrease in skin pigmentation). Occasionally this change may be permanent.
Other reactions are extremely rare. It is possible to cause damage to structures during the needle insertion. Occasionally a skin nerve is irritated, but this usually settles with time and massage of the area.
More than just a painkiller: Cortisone is not just a painkiller. It is an anti-inflammatory, and as your condition improves, you will notice a reduction in pain. As the cortisone injection decreases pain, it can also help relieve pain in the affected joint.
Cortisone injections form part of an overall management program for shoulder conditions.