Download 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.
Cortisone Injections – Patient Information
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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 hypoglycaemic 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.
MSM Pain Clinic, 150 Glasgow St. Wanganui
Tel. 06 3457007, Fax 06 345 7011