Cortisone injections. Tell us more

Cortisone injections. They’re a hot topic in the Medicine and Sport’s Science world. What are they? What do they do? Do they work? Let’s start to unravel this topic and see if there’s an answer. 

Let’s start with the basics, what are Cortisone Injections? The injections themselves are often a combination of local anaesthetic and cortisone which is a steroid1. They are commonly injected into joints such as the shoulder, ankle, knee, elbow, hip and even the smaller joints of the hands and feet2. Cortisone injections are designed to relieve pain and inflammation in conditions such as osteoarthritis, bursitis, plantar fasciitis and tendinopathy to name a few2. A local anaesthetic or numbing spray is often used to numb the injection area, then the needle is injected, and ultrasound is often used to help guide the needle into the correct position2. It is often understood that it can take between 24 to 48 hours for effects to occur1. 

But do they work? Do they actually relieve pain? Are there any benefits to having these injections? Let’s take a look at the research. A study in 1998 set out to determine whether cortisone injections are effective in shoulder pain. They discovered cortisone did in fact improve pain, shoulder disability and range of motion4. Another study in 2007 trialled the effects of cortisone injections and the effects of placebo injections in the hip. The study showed that the cortisone led to significant improvements in pain and function, 3 months after the injections3. It also showed no significant side effects. Finally, to prove the point, another study in 2004 compared cortisone injections to local anaesthetic pain, and like the previous studies, cortisone injections saw greater improvements in pain at both 3 and 12 weeks after injection3. 

That sounds great doesn’t it? I could finish up this blog now, however there is other research out there that questions this. It started in 1997 where an article reported that improvements from cortisone injections are often short-lived and can have a similar effect to a placebo5. To add to this, a recent study in 2017 tested the effectiveness of cortisone injections in the shoulder for adhesive capsulitis. It was discovered that the cortisone injections did provide pain relief, however this was only short-term (between 0 and 8 weeks) and it rather did not last long-term (between 9 and 24 weeks).

So, what’s the verdict here? Research has clearly shown that cortisone injections can help to relieve pain and improve function of the joint. The question is how long will it last on average? It isn’t quite known yet however we do understand that cortisone injections are not long-term fixes or cures. It is also interesting to note that while these studies identified the benefits of cortisone injections, not every participant in these studies saw improvements. Whilst a large number of participants saw improvements, this shows that cortisone injections can affect individuals differently and not every person will have the same effect. 

The takeaway message here is yes cortisone injections can provide some benefit and pain relief, however this is not a long-term solution as we know it provides short-term relief. How effective it is on each individual is something we are still not sure about. It’s definitely important to have a chat to your Doctor about it. The Physio’s and Exercise Physiologist’s here at Aevum are also willing to give you some information!

References:

1. http://www.orthosports.com.au/content_common/pg-cortisone.seo

2. https://www.mayoclinic.org/tests-procedures/cortisone-shots/about/pac-20384794

3. Kruse, D. W. (2008). Intraarticular cortisone injection for osteoarthritis of the hip. Is it effective? Is it safe?. Current reviews in musculoskeletal medicine, 1(3-4), 227-233.

4. der van Windt, D. A. W. M., Koes, B. W., Deville, W. L. J. M., Boeke, A. J. P., De Jong, B. A., & Bouter, L. M. (1998). Effectiveness of corticosteroid injections versus physiotherapy for treatment of painful stiff shoulder in primary care: randomised trial. Bmj, 317(7168), 1292-1296.

5. Creamer, P. (1997). Intra-articular corticosteroid injections in osteoarthritis: do they work and if so, how?. Annals of the rheumatic diseases, 56(11), 634-635.