Cortisone Injections

NOTICE: If you are in the process of receiving any vaccine, you should hold off on having a cortisone (steroid) injection.  You should avoid all steroids for the two weeks prior to your vaccine and then wait another two weeks after your vaccination has been administered. Steroids can limit your body’s ability to respond to the vaccine.

If you are on Coumadin/Warfarin/Jantoven, you will need an INR blood test within 24 hours of the injection. Your INR needs to be less than 3.5 for an injection to be safe.  Other Blood thinners do not need lab work.  Dr McMahon does not ask his patients to stop any blood thinners for his injections.

If you are on an antibiotic, please alert our medical staff. There is no interaction between antibiotics and cortisone.  However, sometimes an active infection is best treated completely before having a cortisone injection.  The medical team will make sure an injection is right for you.

What is Cortisone?

Cortisone is a man-made steroid that imitates the effects of the cortisol hormone. It is a strong medicine that interrupts the production of inflammation in soft tissues in the body. Cortisone does not heal arthritis or repair damaged structures, it treats pain and inflammation. Cortisone is injected into the painful body part by your doctor.

Cortisone Injections at Atlantic Orthopaedics

Cortisone injections can offer patients non-operative pain relief to a variety of orthopedic conditions, such as arthritis or tendonitis. At Atlantic Orthopaedics, our providers work with you to identify the area of your pain and determine if a cortisone shot is an appropriate treatment path for you.

When is a Cortisone Injection not appropriate?

We are very cautious with the use of cortisone injections under a few circumstances.  Your doctor will not perform a cortisone injection into a body part if surgery is planned in that location in the next couple of months. We also avoid injections in patients with an active infection (there are some exceptions), fever, or if they have poorly controlled diabetes.  There are not a lot of medication interactions with cortisone, however we are careful with patients on blood thinners and patients who are planning vaccination in the near future. There are a few tendons in the lower extremity, such as the Achilles and patellar tendon, that we do not inject as there is a risk of tendon rupture.

What do I expect during the Cortisone Injection?

The injections are relatively quick and are performed in the office in a normal exam room. The location of the injection is identified and prepped with an anti-septic.  All injections include an anesthetic which helps reduce pain and disperse the cortisone.  Some doctors use ultrasound to guide the injections more precisely to the target body part.  Injections can be painful, but they are usually quick and soon after the anesthetic will provide temporary relief.

 What do I expect after a Cortisone Injection?

Can I drive home?

Yes. Most people leave their injection feeling fine. Injections into the sacroiliac joint can sometimes make the leg feel weak for 2-3 hours. In these instances, some people may need a ride home.

How long does the anesthetic last?

Patients typically feel the numbing effect for 2-3 hours. After the numbing effect fades, patients often return to their normal level of pain until the cortisone begins to work.

When will the cortisone injection start to work?

Cortisone typically takes a few days (or even a week) to kick in and alleviate pain. There may be a few hours of temporary relief from anesthetic. Please allow one week to pass before assessing the benefit of the injection.

What are the side effects?

Some people become lightheaded following an injection. This is typically thought to be a stress reaction to the procedure and not a reaction to the medications. This is best managed with rest and elevating the legs above the level of the heart. A drink of cool water and a cool wet facecloth on the forehead can also help.

A small number of people will get a flare of painful symptoms when the numbing medicine used in the injection wears off.  This pain can be significant pain but typically lasts less than 24-48 hours. This pain should be managed using your typical pain medications and ice.

Diabetics should pay close attention to blood sugars as cortisone can make blood sugars go up. Headache, fatigue, blurred vision, thirst, and frequent urination are signs of hyperglycemia.  If this becomes a problem, please reach out to the doctor that manages your diabetes.

Other potential side effects include:

• Joint infection
• Temporary facial flushing
• Tendon weakening or rupture
• Thinning of skin and soft tissue around the injection site
• Whitening or lightening of the skin around the injection sit

How do I care for myself after a cortisone injection? 

• Protect the injected body part for a day or two. Avoid hard work, exercise, physical therapy or any activity if it directly engages the body part.
• Apply ice to the injection site as needed to relieve pain.
• Anti-inflammatory medicines and acetaminophen are OK to use for pain.
• Avoid a bathtub, hot tub or pool for two days. It’s OK to shower.
• Watch for signs of infection, including increasing pain, redness and swelling that last more than 48 hours. Infection is a rare side effect and usually takes several days to present.

How long will the cortisone injection last?

The longevity of a cortisone injection varies depending on the individual, the orthopedic condition or injury, and a number of other factors. In general, an injection for arthritis should provide 2-6 months of pain relief, however there is no way to predict the effectiveness. Injections can be repeated as needed, but no sooner than three months. Frequent injections may cause the effects of the cortisone shot to wear off sooner. Repeated or excessive doses of cortisone into a joint or tendon may also cause deterioration in soft tissue structures. For patients with minor injuries or conditions, repeat injections can further damage the tissue or make surgical solutions less effective, so it is crucial to speak with your provider when considering a cortisone injection.

Cortisone Injection Consultations & Appointments

Schedule a consultation to discuss your joint pain with our sports medicine experts. We will determine if a Cortisone Injection is right for you or if another treatment path is advised.

603-431-1121 (Portsmouth, NH)
207-363-3490 (York, ME)
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