Cortisone Shoulder Injections
What is cortisone?
Cortisone is a steroid that is normally produced by your body. Its main purpose is to prevent the release of substances in the body that cause inflammation. There are multiple brands of man-made cortisone to allow us to assist the body in reducing swelling and inflammation, thereby eliminating pain. These injections are frequently done intra-articular (within a joint space) or within the bursa, a space which is responsible for reducing friction and providing lubrication to the structures surrounding and supporting a joint or tendons, such as the rotator cuff.
Why have an injection?
Diagnostic – You may be getting an injection to help your specialist identify the location of pain and confirm findings. This is often the case in acromioclavicular joint (AC joint) injections.
Therapeutic – You may be getting an injection to reduce swelling, inflammation and pain within the joint or bursa. These injections are often helpful in early frozen shoulder or adhesive capsulitis. Such injections often help patients to reduce pain so they can start on physiotherapy or a home rotator cuff and shoulder conditioning program.
Shoulder injections often serve both of these functions. They confirm the location of your pain, and if the corticosteroid works then you may experience a long-lasting decrease in your pain.
How is the Procedure performed?
Your shoulder injection will be performed by a professional health care provider in the clinic or in the diagnostic imaging department by a radiologist.
The skin of your shoulder will be marked and the injection site will be sterilized prior to the injection. The injection will be performed with sterile technique to reduce any chance of infection. The cortisone will be mixed with an anesthetic (usually Lidocaine) to help us both verify the needle placement was correct and to dilute the solution minimizing breakdown of structures.
Radiologists use fluoroscopy (real-time x-rays) and ultrasound to locate injections. Your treating healthcare provider may want a radiologist to perform the procedure in some cases to have proof of the placement of the needle in the correct location.
Side effects of cortisone?
There are a few minor and rare side effects of shoulder injections that you need to be aware of.
- Elevated blood sugar
If you have a history of elevated blood sugars and/or diabetes this is a common occurrence. Closely monitor your blood sugars if you take insulin, as you may require some dose adjustments in the first 48 hours.
- Facial flushing
You may experience a facial flushing sensation or redness of the face. This can begin within a few hours of the injection and last a few days.
Some patients have discomfort after the injection and even experience worsening pain for up to 3 days after the injection. This pain can be minimized by ice packs and analgesics, such as Tylenol or ibuprofen.
Whenever there is a break in the skin, there is a chance of infection. There is a 1 in 200,000 risk of infection even with the use of sterile equipment and proper cleanse of the skin.
- Weakening of tendon
High doses of cortisone and frequent exposure of cortisone can cause weakening of the tendons of the rotator cuff. Ask your specialist what the recommendations are for frequency of cortisone injections to minimize this risk. In general, a maximum of two injections in the subacromial bursa would be given prior to a discussion of other options.