Cortisone Shots Help Painful Joints

Posted on Thu, Aug. 04, 2005

By Stephen Daniels

Fred, a 52-year-old salesman, began to have hip pain one evening after an especially tough tennis match with his neighbor. The pain persisted for a week, so he went to see his doctor.

Shantee, 23, works as a restaurant server while attending college, and her elbow has been hurting when she uses her arm or hand. Felicia, a 68-year-old widow who cares for her grandchildren three days a week, complains that she can't sleep at night because of shoulder pain.

Each of these people may be a candidate for a cortisone shot directly into the painful area. In many situations, these shots offer instantaneous pain relief that can last for months or years. The shots can be repeated periodically as needed and as directed by your doctor.

These shots consist of a combination of two medicines: a local anesthetic to give immediate pain relief and to help the doctor know that he or she has injected the right spot, and cortisone, a type of "steroid" that helps reduce inflammation within a day or two.

This technique may work well in the shoulder, elbow, wrist, hand, hip and knee. This steroid is different from the one some athletes use to enhance their performance in sports.

The type of injury can vary. Sometimes, as with Fred above, overusing the hip muscles during a single day's activities causes the problem. Other times, the recurrent use of a certain part, as with Shantee's elbow and Felicia's shoulder, provokes the injury.

Most often the inflammation is not in the joint itself, but in the tendons ("tendonitis"), which are the dense tissues that connect muscles to bones, and in the bursas ("bursitis"), or sacks, that act to cushion these tendons where they rub against bones.

Some patients fear cortisone shots, having heard that they are painful, or that cortisone is dangerous.

In my experience, the pain of injection is usually minimal and brief, and periodic cortisone injections around tendons, ligaments and joints are safe.

Cortisone can temporarily increase blood sugar, so one must be cautious when injecting diabetics. This side effect is generally manageable by frequent blood sugar level testing, and temporarily increasing the diabetes medication if needed.

Injecting the Achilles tendon behind the ankle can cause tendon rupture, so I don't inject this area. And injections of the heel can be extremely painful, so I ask a podiatrist to determine the best treatment for an inflamed heel.

Injections in the chest or mid or upper back can puncture the lung, so particular care must be taken in these areas. Cortisone injections into the spinal column for back pain require special training and the use of x-ray techniques to ensure proper placement.

Some doctors prefer to try watchful waiting for a few weeks, physical therapy, and other less invasive treatments first, which is fine. Many sore joints improve after a period of rest.

But if your doctor offers you this treatment, consider it carefully. As an experienced physician said to me years ago when I refused to get such a shot for my painful shoulder: "Come back when you're ready to get better." I did, and my shoulder did.

Few treatments bring as many grateful comments from my patients.

Daniels practices family medicine at the Pittsburg Health Center.