Professional Orthopedic Associates of Southern NJ (POASNJ)

Cortisone Injections

Joseph Kozielski, MD, FACS 

Walter Poprycz, MD, FACS

POASNJ@aol.com 

Cortisone Injections

A gland in your body known as the adrenal gland naturally produces a type of steroid called Cortisone. Whenever your body is under stress, natural cortisone is released from the adrenal gland and flows directly into the blood steam, but this natural cortisone is very short-lived; it only lasts for a few minutes. Synthetically produced products of cortisone last much longer.

Depomedrol, Celestone and, Kenalog are three such synthetically produced products of injectable cortisone. They are a close derivative of your body's own natural cortisone. Synthetic cortisone is much more potent than natural cortisone and is injected into a specific area of body where inflammation is present. Since synthetic cortisone is not released by the adrenal gland, it does not go directly into the blood stream. This is why synthetic cortisone will stay in the body for days, a much longer period of time than natural cortisone. The most significant distinction with synthetic cortisone is that it’s put directly into a particular area of the body that is inflamed; it is not injected into the blood stream. Also, synthetic cortisone is designed to act more effectively and remains in the body for a much longer period of time, giving the patient sustained relief.

Because cortisone is a powerful anti-inflammatory and not a pain-relieving medication, it treats pain much more effectively; yet, it only relieves pain at the site of the inflammation. When the inflammation resolves, the pain is lessened. By injecting the cortisone directly into the site of inflammation, even giving high doses, there are usually, only minimal side-effects. A long-lasting effect can take place rapidly and give comfort to the patient, for many weeks.

When inflammation is a chronic problem many conditions, such as arthritis or bursitis resolve when cortisone shots are given. Tennis Elbow, Carpal Tunnel Syndrome and Ganglions are a few conditions that can be helped with cortisone injections.

In many cases, cortisone injections can be given with a very small needle, thus the patient will have very little discomfort. But, sometimes, a slightly larger needle must be used when extracting fluid through that needle, before the injection of cortisone is given. When injections are given directly into a joint, they can be slightly painful. But, pain can be alleviated with Lidocaine, a topical anesthetic that numbs the skin around the inflamed area that is ready to be injected. When Lidocaine is mixed with the cortisone, it provides temporary relief, a numbing effect around inflamed area, right before the shot is given.

There are rarely, allergic reactions to cortisone injections, since it is a naturally, occurring substance. However if you are allergic to Betadine or any other preparations used to treat or sterilize the skin, please tell your physician before receiving the injection. It is rare, but an infection can also be a serious side-effect with cortisone injections, especially when the shot is given directly into a joint. Yet, when the skin is properly sterilized, by using Betadine or iodine, along with alcohol, this usually prevents a serious infection. Sometimes there are other side-effects when cortisone shots are given. People with darker skin can experience“whitening” around the injected area. Even though it is cosmetically uninviting, it is not harmful. Also, there is a condition known as a “cortisone flare”. This condition can cause a period of brief pain, even worse pain, than before the cortisone shot was given. With “cortisone flare”, when the shot is administered, sometimes it crystallizes and causes pain that may last up to one or several days. Icing the affected area where the injection was given is the best way to treat “cortisone flare. Also, people with diabetes should be aware of a transient blood-sugar fluctuation. When injected with cortisone, they may have a brief increase in their blood-sugar level and should be closely monitored until their blood-sugar returns to a normal range.

Cortisone injections are safe, when given more than once. But, if the injections do not offer any relief, or wear off too quickly, you may want to seek an alternative method of care. Sometimes tendons can weaken and softening of cartilage may occur with repeated cortisone injections. Continuous injections may also increase the risk of a more serious problem; this is why many doctors do not give cortisone injections more than three times, consecutively. 

Copyright ©2006 by Joseph Kozielski, MD-- with Dolores Kozielski

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