What are steroid injections (cortisone shots)?

Steroid injections (corticosteroid injections/cortisone shots) are injections given by a healthcare professional directly into joints or other areas of the body to relieve symptoms such as pain, inflammation, or restricted movement. They are commonly used to treat shoulder, knee, and other joint pain, tendonitis, bursitis, back pain, or arthritis or to manage conditions such as sciatica, inflammatory bowel disease, and skin conditions such as psoriasis. Examples of steroids given by injection are hydrocortisone (Solu-Cortef), triamcinolone (Kenalog-40), and methylprednisolone (Depo-Medrol).

How are steroid injections given?

Steroid injections can be administered by your family doctor, internist, or in a hospital or specialist clinic.

Your healthcare provider will explain the procedure, have you sign a consent form, and position you for the injection. You should wear loose-fitting clothes to make it easier for them to inject the steroid. They may use ultrasound to locate the injection site accurately. Depending on where it is being injected, the steroid injection may also include an anesthetic (numbing medication), with the numbing effect kicking in quickly to alleviate any discomfort.

The whole procedure will take around 10 to 15 minutes but it only takes a couple of minutes to inject the steroid shot. You can usually head home shortly after the procedure, but it's a good idea to rest the treated area for a few days afterward. If you have received a local anesthetic, you might want to arrange transport home because numbness from the anesthetic can make it difficult to drive.

Avoid any activities that might strain the area for the remainder of the day and the next five days.

Where are steroid injections given?

Steroid injections directly into joints or other areas of the body. They may be given a different name, depending on where they are given. For example, steroid injections that are given into:

• A joint are called intra-articular steroid injections
• A muscle are called intramuscular steroid injections
• The spine are called epidural steroid injections
• The bloodstream are called intravenous steroid injections.

Steroid injections can also be given directly into inflamed bursae (bursae are small fluid-filled sacs that reduce friction between moving parts in your body's joints) to treat bursitis, or around inflamed tendons (the connective tissue that joins muscle to bone) to treat tendonitis.

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How long does it take for a steroid injection to work?

Most steroid injections take a few days to reach their full effect although you may notice some symptom relief within a few hours. Some injections may also be combined with a local anesthetic that provides immediate but very short-term relief, typically only lasting a few hours and you may have to wait a couple of days before the pain-relieving effects of the steroid kick in.

Steroid injections do not provide relief for everyone, for example, lumbar epidural steroid injections are not always effective, but when they do work it may take 1 to 5 days. Normally, if the first injection proves effective, you can have up to three injections in a single year.

How long do steroid injections last?

Steroid injections are not very long-lasting treatment – their effects typically only last a few weeks to a few months. But they can last longer when combined with other treatments such as physical therapy. They can also help you bide your time and relieve pain while you delay or wait for other, more permanent treatments, such as surgery.

You shouldn’t have more than three steroid injections a year. Excessive injections can damage the tissue around the injection site.

Are steroid injections painful?

As the needle goes into your skin you may feel a little discomfort or a slight stinging, but it is uncommon to feel intense pain. The injection contains slow-release crystals of corticosteroid medication, which helps provide relief for longer, but these can irritate the joint temporarily. Most injections into a joint (intraarticular injections), bursae, or around tendons, are usually combined with an anesthetic which quickly helps overcome any pain and your healthcare provider may also rub local anesthetic onto the injection site area which can help with any initial stinging.

Once the local anesthetic wears off (usually within a half to one hour) you may have some residual numbness and it is not uncommon to experience a short-term flare in joint pain or swelling or irritation but this usually improves within a few days.

If you feel worried or anxious about your steroid injection, talk to your healthcare provider before you have it.

Where is the most painful place to get a steroid shot?

The most painful place to get a steroid (cortisone) shot is into the palm, sole, or any small space (such as an ankle joint). The size (length) and gauge (width) of the needle can also factor into the amount of pain you experience.

Learn more:

• Adrenal cortical steroids
• What are the side effects of steroids?
• Anabolic steroid abuse, side effects and safety