What is a cortisone injection and what does it do to your body?
Cortisone is a powerful anti-inflammatory medication and is naturally produced in the body. Cortisone injections are commonly used to treat a wide range of musculoskeletal conditions including muscular tears, tendinopathies, bursitis and arthritis etc. As with nearly any procedure where medication is introduced into the body, there are a number of adverse reactions that may occur.
Some of the common side effects can include;
Soft Tissue Death: Cortisone injections are harmful to certain types of tissues including tendons. A 2014 systematic review concluded that there is emerging clinical evidence showing significant long-term harm to tendon tissue and cells associated with glucocorticoid injections. (Dean BJ, 2014) These effects include increased collagen disorganization and necrosis.
Infection: Injection associated infections can occur in any intradermal, subcutaneous, intraarticular and intramuscular injections. The use of best infection control practices can help to minimize these risks with any needle injection.
Osteonecrosis: Repeated cortisone injections have the potential for osteonecrosis (bone death) and bone thinning (osteoporosis). In this 2010 case report, a single hip joint corticosteroid injection caused rapid onset avascular necrosis in a 79-year-old man with no comorbidities (Kassam, 2010).
Cushing's Syndrome: Exogenous Cushing’s Syndrome is a form of Cushing's Syndrome that can occur in people taking corticosteroids with symptoms including bruising, bone weakness, increased hair growth, and infertility. It usually develops in long-term exposure to corticosteroids, but a 2016 study in the Medical Journal of Case Reports found that there have been a few reported cases of the development of Exogenous Cushing’s Syndrome after a single dose of glucocorticoid in the literature. (Mohamad Motawea, 2016)
Increased Blood Sugar: Cortisone can have an effect on increasing blood sugar levels in people with diabetes as discussed in a 2014 study in the Journal of Hand Surgery. (Jeffrey G. Stepan, 2014)
Cortisone Reaction: The injected cortisone can crystallize in the body and cause an increase in inflammation and pain. Although uncommon this cortisone flare can last for one to two days.
Cortisone injections may treat the present symptoms but don't often treat the cause of the condition. It is important to be assessed by your Physical Therapist and Physician to determine if a cortisone injection is recommended for your specific condition. For all medical interventions, it is important to weigh the risks vs. benefits when determining the best approach for treatment.
Dean BJ, L. E. (2014). The risks and benefits of glucocorticoid treatment for tendinopathy: a systematic review of the effects of local glucocorticoid on tendon. Seminars in Arthritis Rheumatology, 570-576.
Jeffrey G. Stepan, B. D. (2014). Blood glucose levels in diabetic patients following corticosteroid injections into the hand and wrist. Journal of Hand Surgery , 706-712.
Kassam, A. M. (2010). Accelerated avascular necrosis after single intra-articular injection of corticosteroid into the hip joint. BMJ.
Mohamad Motawea, (2016). Cushing Syndrome Following Single Steroid Injection: A Case Report and Review of the Literature. American Journal of Medical Case Reports, 4, 130-133.