Injection Advice

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1. What is cortisone and how does it work?

• “Cortisone” is the name of a group of medicines that are very strong anti-inflammatories. Cortisone can help reduce the pain of a tendon, joint, or nerve that is inflamed.

2. How is cortisone given?

• Cortisone can be taken as a pill, but an injection is usually safer and more effective because it puts the medication directly where it is needed.

3. What conditions are treated with cortisone?

• Almost any painful tendon, joint, or nerve condition can be treated with cortisone. Most conditions respond well.

4. Is cortisone a cure, a temporary fix, or is it just “masking the problem”?

• Cortisone can be a cure for pain that is due to an inflamed tendon, joint, or nerve after a minor injury.
• Cortisone can be a temporary fix for pain that is due to a minor injury, but the patient doesn’t want to take the required time to heal properly. For example, a golfer who gets “Golfer’s Elbow” at the beginning of golf season.
• Cortisone is just masking the problem for pain due to long-term physical stresses that are not being changed. For example, a secretary who gets carpal tunnel syndrome but can’t retire for many more years.
• No injection therapy can be expected to 100% cure a chronic wear-and-tear condition such as osteoarthritis, chronic tendonitis, or chronic nerve pain. An injection can, however, give an extended period of symptom relief.

5. How frequently can cortisone be given?

• There are no lifetime limits on cortisone. Most doctors agree that it is usually safe to give injections every 3 months. However, if you do need more than one or two injections, you may want to start considering other options.

6. Are there any complications?

• Short term: Sometimes patients will describe a “hot flushing” sensation. If you have diabetes, cortisone can cause a brief rise in your blood sugar. A very small percentage will get a lot more pain for 48 hours before the pain actually reduces.
• Long term: Repeated cortisone injections can cause tendon damage or worsening arthritis, but it depends on the situation. Multiple knee injections are probably safe, but tendons should not be injected repeatedly.
• No medical treatment is 100% safe. A tendon or joint pain may sometimes worsen in the weeks after an injection. This is uncommon and hard to predict. If you have concerns, please discuss it with the doctor before the injection.

7. What can I expect from the injection?

• Immediate: All needles and injections cause some pain. The amount of pain depends on the sensitivity of the body part and sometimes on your fear of injections.
• Intermediate: The cortisone is mixed with a numbing medicine, so you will usually experience a kind of numbness for many hours. When that wears off, many people will get a dull ache or throbbing sensation. A very small percentage will get a harmless, but very painful, “cortisone flare,” increasing their pain for 48 hours.
• Long term: It may take anywhere from a few days to a few weeks to feel the full benefits of your injection. Book a follow-up with the doctor if it does not help.

8. Final Thoughts

• When used appropriately, cortisone is safe and effective. Even as we head towards the middle of the 21st century, cortisone is still one of our most trusted treatments for tendon, joint, and nerve pains.
• Please be sure to ask the doctor all your questions before your injection.

7 Days Before Treatment

• Lighten your schedule. Try and lighten your schedule for 1 day after treatment. Please arrange for a driver.
• No anti-inflammatories. Do not take anti-inflammatories for 7 days before treatment, including: Aleve, Advil, Aspirin, Celebrex, Diclofenac, Ibuprofen, Naproxen, and Voltaren. Tylenol is OK.
• Buy the prescribed painkillers. Tendons or ligaments: Almost everyone will need many doses of Codeine or Percocet. Joints: Almost no one will need a painkiller, and some even feel better very quickly.

1 Hour Before Treatment

• Tendons or ligaments: If you have a driver, take a painkiller. If you do not, wait until you are home.
• Joints: Almost no one needs a painkiller.

First 24 Hours After Treatment

• Pain relief: Use a non-anti-inflammatory painkiller such as Tylenol, Codeine, T3, or Percocet.
• Ice or heat: Apply ice if you wish, or heat if you prefer. Use for 10 minutes, followed by 20 minutes off.
• Showering: Showering is fine, but avoid soaking in water such as baths, pools, or hot tubs.

First 3 Days After Treatment

• Monitor pain, warmth, and swelling. If concerned, call us.
• Tendons or ligaments: Most people will have increasing pain for 24 hours, reducing slowly afterwards.
• Joints: Most people will have only mildly increasing pain for 24 hours, but many feel just fine.

First 7 Days After Treatment

Movement is a stimulus for strengthening, but not too much.

• Tendons or ligaments: Immobilize the area for 1 hour. Then perform very gentle stretching for 3–5 days.
• Joints: Not Allowed: No jarring or bouncing movements for 7 days. No running, jumping, or Boot Camp.
• Joints: Allowed: Stationary cycling, elliptical machines, and swimming. Please reduce intensity by 50%.

Infection Warning: Infection may occur, but is rare. Watch for heat, redness, and swelling that doesn’t feel right to you. If this happens, you must be seen by a doctor within 24 hours. See us, your GP, or Urgent Care / ER.