Cortisone infiltrations are injections used to relieve pain and inflammation in a specific region of the body.
Cortisone is commonly injected into joints, such as the ankle, elbow, hip, knee, shoulder, hand, wrist, and spine.
The injections can also benefit the smaller joints in the hands and feet and they can be successfully used to treat carpal tunnel.
The effectiveness in plantar fasciitis (inflammation of the sole tendon plate) or a snap finger is low; here other therapies should be preferred.
The cortisone injection contains a steroid-based drug and a local anesthetic.
In many cases, the infiltrations can be administered in the office of the attending physician.
Due to the possible side effects, only a limited number of cortisone injections can be obtained over the course of a year.
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What is a cortisone injection?
A cortisone injection is useful in the treatment of numerous diseases and ailments.
Cortisone is a steroid-based drug.
Steroids have a strong anti-inflammatory effect, in addition, they regulate the activity of the immune system.
For the injections there is a wide range of drugs based on cortisone.
Cortisone injection is the general term for injecting any of these agents. Their task is to inhibit inflammation. As the inflammation subsides, the pain is also alleviated.
Infiltration is only one method of therapy; one should discuss with the doctor the different treatment options before deciding which one is best for the respective disease.
Cortisone injections can be divided into two categories:
- Local injections to relieve inflammation in a limited region of the body; Examples include joint injections and epidural infiltrations (into the spine).
- Systemic injections that fight inflammation throughout the body to regulate the activity of the defense system. The systemic injections are used for conditions that affect more than one region of the body, such as rheumatoid arthritis, cancer, collagenoses, respiratory problems or allergic reactions.
Inflammatory mechanism
Inflammation is one of the body’s first reactions to a wound or injury.
At the moment of injury, damaged cells and tissue residues are released.
These secreted body particles act like antigens to stimulate a non-specific defense response and cause the spread of white blood cells (leukocytes).
As a protective mechanism, the local blood flow becomes stronger to transport the leukocytes, macrophages and proteins of the plasma to the injured region.
The redistribution of the arterial flow causes blood stasis (congestion) and oxygen deficiency (hypoxia) at the injured site.
The arrival of white blood cells, plasma proteins and fluid into the tissue structures causes reddening, swelling and pain – the typical features of inflammation.
Effect of cortisone
The mechanism of action of cortisone is based on the reduction of the inflammatory reaction by restricting the capillary vessel width and the permeability of the vascular structures.
This substance reduces the accumulation of leukocytes and macrophages and lowers the release of kinins, which are responsible for the dilation of blood vessels (vasodilation).
Cortisone inhibits (blocks) the release of destructive enzymes that attack the injured tissue, also destroying healthy tissue in the process.
Recent research also shows that cortisone can reduce the formation of prostaglandins, which are partly responsible for the inflammatory process.
Cortisone injections can be used to treat various conditions and conditions, including:
- Baker’s cyst
- Bursitis in the shoulder
- Carpal tunnel syndrome
- Chondromalacia
- Quervain’s disease
- Frozen Shoulder
- Gout
- Rheumatoid arthritis
- Lupus
- Morton’s neuralgia
- Myofascial pain syndrome
- Arthrosis
- Plantar fasciitis
- Metatarsalgia
- Psoriatic arthritis
- Rotator cuff injuries
- Sarcoidosis (Boeck’s disease)
- Tendonitis (rare, because it can cause tissue damage)
In what form is a cortisone injection administered?
Cortisone infiltrations can be administered in various forms.
- Epidural injections: The doctor injects a cortisone-based medicine near the spinal canal to relieve inflammation in the spine. As the inflammation subsides, the pain caused by discomfort in the spine, such as spinal stenosis (narrowing of the spinal canal), herniated disc in the lumbar region and injuries to the spinal cord nerves, also subsides.
This is a form of local injection.
For epidural injections for back pain, the doctor usually combines the steroids with a local anesthetic (such as lidocaine). - Joint injections: The doctor injects the cortisone directly into the joint. This is a form of local injection. Most often, these injections are administered in the office of the attending physician. In the case of joints that are difficult to access, such as the hip joint, a guided injection can also be carried out in a hospital or clinic with the help of X-ray machines or ultrasound machines.
The doctor may combine the cortisone preparation with a local anesthetic.
As a rule, however, hyaluronic acid infiltration or physiotherapy (Tecar or magnetic therapy) are preferred, because the side effects of cortisone are eliminated here.
- Intralesional injections: The preparation is injected directly into the skin injury (e.g. acne or keloid).
A keloid is caused by excessive collagen growth on a scar (bead scar) or wound. The doctor may mix the cortisone ampoule with a local anesthetic. These syringes are a form of local injection. - Intramuscular infiltrations: the cortisone preparation is injected directly into a muscle.
These are systemic injections.
They are designed to relieve inflammation in at least two regions of the body. For intramuscular injections, the doctor may combine the cortisone with a local anesthetic. - Intravenous injections: They are injected directly into the vein. It is a form of systemic injection. As a rule, intravenous cortisone injections are administered in the hospital to treat serious diseases.
What are the benefits of cortisone injections?
If the joint is swollen, the synovial fluid is sometimes aspirated before the cortisone is injected.
The suctioned fluid can be examined in the laboratory to fathom the cause of the joint inflammation.
This is a great advantage because this laboratory test provides very precise results.
Another advantage of cortisone injections is that the inflammation in a certain region of the body can be combated faster and more effectively than with the conventional, orally administered anti-inflammatories, such as aspirin.
A simple injection can also avoid some side effects that can occur with many oral anti-inflammatories, most notably stomach irritation and stomach ulcers.
Cortisone injections are easy to administer in the doctor’s office.
Other advantages lie in the rapid action of the drug and in the fact that undesirable side effects are limited to the infiltration site.
Cortisone joint infiltration does not lead to weight gain or general bloating of the body.
After infiltration, some patients experience redness and feel warmth in their chest and face.
If the patient suffers from diabetes, the cortisone injection can raise the blood sugar level in the short term.
After the injection, the following medical recommendations may be given:
- The injection point should be protected and spared for one or two days. For example, if injected into the shoulder, lifting heavy loads should be avoided.
With an injection into the knee joint, as little time as possible should be spent on the legs. - If pain occurs, the puncture area can be cooled with ice packs.
- Pay attention to signs of infection; these include intensification of pain, redness and swelling lasting longer than 48 hours.
Side effects of cortisone
Probably the most common side effect is inflammation caused by cortisone; here the injected cortisone crystallizes and can aggravate the pain for a short time.
This effect usually lasts 24 – 48 hours and the affected area should be treated with ice.
One usually tries to avoid infiltrations in the heel, Achilles tendon and elbow (in the case of tennis elbow) because they can promote the formation of calcium deposits.
Another relatively common side effect is the pale skin coloration at the injection site.
This only affects people with dark skin and is not dangerous, but patients should be informed about this possibility.
Other side effects of cortisone injections can be quite serious.
First and foremost is certainly the infection, especially if it occurs as a result of joint infiltration.
The best precaution is to take all possible precautions, such as disinfecting the skin with disinfectant and/or alcohol.
Diabetics may experience a temporary increase in blood sugar levels; This must be carefully monitored.
Infiltrations should be avoided during pregnancy and lactation.
Infiltration into a tendon can lead to weakening or even a complete rupture of the tendon.
Since cortisone is a natural substance, there are no allergic reactions to the injected substance. However, one can be allergic to other substances contained in the ampoule or to the skin disinfectant (e.g. Sagrotan), which many doctors use to disinfect the skin.
Other contraindications include glaucoma, high blood pressure and osteoporosis.
How often can cortisone be injected?
As a rule, a treatment cycle includes three cortisone injections at weekly intervals.
If they have shown effect, the application can be repeated after six months at the earliest.
Are the infiltrations painful?
The sensation of pain depends very much on the individual patient; some have only mild discomfort during puncture, for others the injection is quite painful.
With three joint infiltrations performed each time by the same doctor, the patient may experience mild discomfort the first time and severe pain the second time.
