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What is a cortisone injection
A cortisone injection delivers a synthetic corticosteroid into a joint, a bursa, a tendon sheath or next to a nerve root. Common drugs are triamcinolone, methylprednisolone, betamethasone and dexamethasone, often mixed with a local anaesthetic.
The corticosteroid strongly suppresses inflammation, so pain and swelling decrease — but the cause, such as worn cartilage, tendon degeneration or nerve compression, remains. The anaesthetic works immediately; the cortisone itself starts working after 1–3 days.
The effect usually lasts from a few weeks to 2–3 months. That makes it a useful tool for a flare-up, but not a way to treat a chronic problem with repeated shots.
At a glance
- Drugs: triamcinolone, methylprednisolone, betamethasone, dexamethasone
- Onset: 1–3 days; anaesthetic immediately
- Duration: a few weeks to 2–3 months
- Frequency: usually no more than 3–4 times a year per joint
- Interval: generally at least 6–12 weeks
- Before joint replacement: usually not within the last 3 months
When cortisone helps
The benefit depends on the diagnosis. In some conditions cortisone gives a good and sometimes lasting result; in others only short relief.
| Condition | What cortisone gives | What to know |
|---|---|---|
| Knee osteoarthritis flare | Relief for a few weeks | Repeated shots every 3 months relieved pain no better than placebo and were linked to greater cartilage loss |
| Shoulder bursitis, impingement | Rapid pain reduction | Without shoulder exercises the pain often returns |
| Early frozen shoulder | Less pain, faster return of mobility | One of the best examples of cortisone’s benefit |
| Trigger finger, De Quervain’s | Often a good effect, sometimes after one shot | Surgery is discussed if it recurs |
| Carpal tunnel syndrome | Relief for weeks or months | Symptoms often return |
| Tennis elbow | Better at 4 weeks | At 6–12 months worse than wait-and-see or PRP |
| Radicular pain (disc herniation) | Short-term relief with epidural or perineural injection | Does not change the long-term course of the herniation |
| Plantar fasciitis | Short-term relief | Risk of heel fat pad thinning and fascia rupture |
The physician decides on an injection after examining you and reviewing MRI or ultrasound.
Side effects of cortisone injections
Common and temporary
Increased pain for the first 1–2 days (“flare”), facial flushing, insomnia, mood swings. In people with diabetes, blood sugar usually rises for 1–3 days, sometimes up to a week.
Local
Lightening of the skin and thinning of the fat under the skin at the injection site. Weakening and possible rupture of a tendon if the drug is injected into it — which is why cortisone is usually not injected into the Achilles or patellar tendon.
Rare but serious
Joint infection — very rare but urgent: increasing pain, warmth, redness, fever. Allergic reaction. With frequent repeated shots: cartilage loss, adrenal suppression and reduced bone density.
If the joint becomes hot and red after the injection or you develop a fever, see a doctor urgently.
Who should not have a cortisone injection
Contraindications
Infection in the joint or of the skin at the injection site, systemic infection with fever, allergy to the drug, bleeding disorders (or anticoagulants without the physician’s agreement), a recent fracture in the injection area, and a joint replacement at the injection site without a specific indication.
Caution needed
Diabetes (blood sugar rises for a few days), uncontrolled high blood pressure, glaucoma, osteoporosis, pregnancy, a recent injection into the same joint — repeats are usually limited to 3–4 per year. Cortisone is not injected into the Achilles or patellar tendon because of the risk of rupture.
Prices are approximate. Each clinic sets its own conditions and price: we send your request to several clinics and forward their offers so you can compare. Price guidance is on the page “Treatment costs”.
Recovery after the procedure
On the day of the injection you can walk and return to your hotel on your own. Intense load on the joint is best avoided for 1–2 days; ice helps with swelling. Then you gradually return to normal activity and exercise. The effect is assessed after 6–12 weeks; if there is no improvement, the clinic physician revises the plan. If you have diabetes, check your blood sugar more often in the first days: it may rise temporarily.
How many shots are allowed and why frequent shots are harmful
There is no strict rule, but most physicians give no more than 3–4 injections a year into one joint, at least 6–12 weeks apart. If two shots each bring only short relief, repeating them usually makes little sense.
Concerns relate to frequent repeated shots. In a randomised JAMA trial, patients with knee osteoarthritis received triamcinolone every 3 months for two years: pain improved no more than with saline, while cartilage volume decreased faster — 0.21 mm versus 0.10 mm.
In tendinopathy, a systematic review in The Lancet found that cortisone works well in the first weeks but gives worse results than other treatments after 6–12 months.
Before joint replacement, many surgeons ask that no cortisone be injected into that joint in the preceding 3 months because of a higher infection risk.
Alternatives to cortisone
| Method | How it works | When it is discussed |
|---|---|---|
| PRP therapy | Growth factors from your own blood | Knee osteoarthritis stages I–III, tennis elbow, tendinopathy. In tennis elbow PRP was better than cortisone at one year |
| Hyaluronic acid | Improves the properties of joint fluid | Knee osteoarthritis; moderate effect lasting several months |
| Exercise and physiotherapy | Strengthens muscles, offloads the joint | The basis of treatment for almost every diagnosis |
| Shockwave therapy | Stimulates tendon healing | Plantar fasciitis, calcific shoulder, tendinopathy |
| Cell-based methods (BMAC, MFAT) | Your own cells and growth factors | More advanced changes; evidence is limited and the physician decides |
Approaches are compared on regenerative methods vs cortisone. PRP is usually not given earlier than 4–6 weeks after a cortisone injection into the same area.
What to do after the injection
- Take it easy for 1–2 days: no running, jumping or heavy lifting.
- After an injection near a tendon, avoid heavy loading of that area for about 2 weeks.
- If the pain increases on the first day, apply cold for 15 minutes through a towel.
- If you have diabetes, check your blood sugar more often for a few days.
- Use the relief to start the exercises your physician prescribes — they bring the long-term result.
If you are being offered a third or fourth injection within a year, consider a second opinion and discuss other options.
Scientific evidence
Key studies on the benefits and risks of corticosteroid injections:
- McAlindon TE et al. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA, 2017.
- Coombes BK et al. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet, 2010.
- Peerbooms JC et al. Positive effect of an autologous platelet concentrate in lateral epicondylitis in a double-blind randomized controlled trial: platelet-rich plasma versus corticosteroid injection with a 1-year follow-up. Am J Sports Med, 2010.
Frequently asked questions about cortisone injections
Find an alternative to cortisone
Describe your diagnosis and how many injections you have had, and attach your MRI. The coordinator replies within 24 hours; a clinic physician will suggest treatment options.
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