Cortisone ("Steroid") Injections

What is cortisone? Cortisone is a naturally-occurring anti-inflammatory hormone that is found in your body.  The body is a balance of inflammation (a preparatory step to healing) and calming down of inflammation.  Sometimes, you can have so much inflammation that the pain it causes prevents you from pursuing the healing process (for example, some shoulder pain hurts so much that you might not even be able to make it to physical therapy!).  The purpose of a steroid injection is to calm down the excessive inflammatory process that may be going on because of injury.  Cortisone injections also can be used to diagnose some conditions such as carpal tunnel syndrome.


CelestoneThere are many forms of cortisone.  I usually use betamethasone sodium phosphate, or Celestone Soluspan.  Some formulations of cortisone have a tendency to cause skin depigmentation (take away the pigment from your skin); in my experience, this particular form causes this effect less frequently than some of the others.


I usually combine the cortisone with a short-acting anesthetic called lidocaine.  Because that lidocaine numbs the area, sometimes we can predict how effective the injection might be at relieving your pain right away.  Unfortunately, that wears off in a few hours and the steroid can take a few days to kick in, so that period in between can be annoying!  In fact, about 1 in 3 people get a “flare” reaction to the steroid.  I am one of those people; a steroid injection makes me feel as if I’ve been hit with a hammer in that area for a day (after the lidocaine wears off); if this happens to you, it will go away.

What are the side effects? Many patients worry about cortisone injections because they have heard so much negative press about steroids. However, a local injection is VERY different from a pill that goes throughout your body; the oral steroids have serious significant potential side effects. Side effects of a steroid injection include infection (any time you poke the skin with a needle you risk that!), flare reaction (as described above), skin depigmentation (as described above), and fat atrophy, which is when the fat under the skin in that area “disappears” and can leave you with a little indentation).  Fat atrophy and depigmentation at early and late stages are shown in the images below. Diabetic patients need to watch their glucose levels much more often for five days, as it has been shown that they can RISE quite a bit for five days after a local steroid injection!!!