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Cortisone Injection Knee

In this article we describe all the benefits and risks of cortisone injections in the knee and provide information about safer and more effective alternatives.

Chronic knee pain can be extremely debilitating. Your knees provide support as you go about your daily activities. If you begin limping to favor the knee on one side and continue to do so for an extended period, you may develop back pain, swelling, arthritis, and other musculoskeletal disorders.

But if you treat knee pain early, without any alternation in your gait , you could prevent various types of limb and joint pain. Your doctor can provide treatment for various types of knee pain, including arthritis, ruptured tendons, and ligament damage. They conduct physical and imaging testing to identify the underlying cause of your pain and then devise a treatment strategy.

If you are experiencing severe pain, your doctor may administer corticosteroids to treat your arthritis symptoms while discovering a more permanent solution. Corticosteroids are available in gel, medication, and pill form.

What Is Cortisone Injection?

Cortisone injection also known as corticosteroid injection is a medication that can alleviate joint pain and swelling in a specific location of the body. Most frequently, they are injected into the joints of the wrist, spine, knee, elbow, hip, and ankle. But cortisone injections can also be injected in your joints of toes and fingers to help relieve pain[1].

Cortisone shots are particularly beneficial to treat inflammatory forms of arthritis, such as rheumatoid arthritis. They provide immediate pain relief and relieve rheumatoid arthritis symptoms. Corticosteroids may also be prescribed for treating other injuries and conditions including: Back pain relief, Gout, knee osteoarthritis, Bursitis, psoriasis arthritis, and tendinitis.

Typically, cortisone injections contain a medication called corticosteroid and a local anesthetic. Generally, you can get this injection at your doctor’s office. Additionally, due to potential negative effects, the number of cortisone injections that can be injected per year is often restricted.

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How Do Cortisone Shots Work?

When cortisone is injected directly into the site of swelling typically joints or tendons, it suppresses numerous immune system components, thereby reducing pain and swelling throughout the body.

Although steroids injections are effective in providing pain relief, it often does not treat the underlying condition causing the inflammation. For example, Injecting cortisone into a joint affected by osteoarthritis may provide immediate pain relief caused by inflammation of joints, but it does not rebuild the patients damaged cartilage[2].

However, when the condition is caused by a brief rise in inflammation, steroids can reverse this process and help relieve pain in certain cases. De Quervain’s tenosynovitis a condition affecting the tendons of the wrist that causes pain and inflammation, is an excellent example, as it is usually related to hormone fluctuations or overuse. In the majority of cases, only one injection can permanently treat the disease[3].

Overall, Corticosteroid injections can promptly reduce joint pain and inflammation associated with arthritis or other inflammatory condition, and the effects can persist from weeks to several months.

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What’s The Procedure For A Cortisone Shot?

The procedure of receiving a cortisone shot is often performed by orthopedic doctors.

At first, you will be asked to wear a hospital gown, depending on the body region being treated.

Then a doctor will clean the injection site with alcohol wipes and leave it to become dry.

After that, the doctor will apply a numbing agent spray to suppress the pain and numb the area.

The doctors will insert a tiny injection with a thin needle into the joint affected by arthritis. After insertion, you may feel some sort of pressure, but numerous people don’t feel pain during this procedure.

How Does It Feel To Receive A Cortisone Shot?

A cortisone shot is injected by the doctor and requires no prior preparation. However, if you use blood thinners, you may need to stop taking them a few days prior to the injection, as they can increase risks such as bleeding and bruising[4].

Clinical practitioners also recommend that you should never discontinue taking blood thinners without the advice of your prescribing doctor. Additionally, if you have diabetes( high blood sugar levels), or some sort of infection always consult your doctor before receiving a cortisone shot[5].

Your healthcare provider will clean the cortisone injection site and may numb the region with an anesthetic spray. Many steroid injections contain a corticosteroid medication or a local anesthetic also called numbing agent such as lidocaine to make the injections more tolerable.

The sensation of the injection depends on where it is administered. Many injections administration are painless or cause only a few seconds of discomfort. However if your doctor injected the cortisone shot into the delicate tissues of the soles of the feet or palm, it will be more painful for you than receiving injections into bigger joints. The lidocaine takes effect quickly, whereas the steroid typically takes several days.

What Are the Risks Associated With Cortisone Shots?

Cortisone shot has the ability to cause minor or serious side effects. But they depend upon the site of injection administration such as the spine, muscle, or joints. However, according to the doctors, some minor side effects of a cortisone injection can occur including pain, redness, and swelling. These minor side effects of cortisone shots develop immediately or within 48 hours of receiving the shot.

Weaken Immunity

Cortisone has the ability to weaken the body natural immune system. This weakening of the body immune system leads to the development of the condition called Multiple sclerosis, in which the body mistakenly attacks its own cells. Due to this risk, many doctors recommend only one cortisone injection every three months for a specific joint and six times per year for the entire body[6].

Raise Blood Sugar Levels

Cortisone can also increase glucose( blood sugar) levels in patients having diabetes. Before administering a cortisone injection, doctors evaluate blood sugar levels to ensure they are stable.

Trigger Osteoporosis

Administration of Steroid injection may also occasionally induce osteoporosis, a disorder characterized by lower bone density.

Infection Risks

Steroid injections carry a danger of infection. Usually, a doctor cleans the skin of the injection site with some disinfectant. Although this action prevents the bacteria from entering the injection area, you can still contract an infection, if you do not properly care for the injection site.

Signs of joint infection include warmth, redness, joint inflammation, fever, and pain. Infection in a joint can be serious. Therefore it is crucial to seek medical attention immediately if you have any of these symptoms of infection at the same place.

Other Side Effects

Other side effects of cortisone shots include body allergic reactions, headaches, and facial flushing. In addition to these fat necrosis which resembles a divot in the skin, and hypopigmentation( pale skin), thinning of the skin, and soft tissue can also occur at the skin injection site.

It can also cause fluid retention including pulmonary congestion and limb edema mood changes and high blood pressure

Repeated cortisone shots damage Intra Articular Cartilage and Soft Tissue

Repeated steroid injections on an affected joint administered in a short period might harm the intra articular cartilage and soft tissue such as ligaments and tendons at the injection site. For this reason:

If repeated cortisone shots must be administered in the same joint, they should be injected over a gap of several weeks. Many doctors prefer to wait at least three to four months for repeated injections. It is also recommended that patients should not receive more than three or four repeated cortisone shots in the same location every year[7].

After a cortisone injection, a surgeon will normally wait three months before operating on the affected joint.

Additionally, it is important to know, patients who use other corticosteroid medication, such as inhaled steroids or prednisone should, if feasible, receive fewer steroid injections or lower doses to minimize the dangers described above[8].

Cortisone Shots Should Be A Part of a Comprehensive Treatment Plan

These steroid injections offer short-term relief[9]. Typically, patients seeking long-term relief are encouraged to:

Involve yourself in physical therapy. Stretching and strengthening exercises of muscles can help relieve pain and improve symptoms in numerous musculoskeletal disorders including arthritis. In fact, research comparing physical therapy and cortisone shots found that physical therapy provided longer-lasting relief.

Reduce your weight. Losing excess weight helps alleviate joint tension. Steroid injections might be less helpful to relieve pain and reduce inflammation associated with knee osteoarthritis in obese patients.

Make lifestyle changes. A natural treatment option to reduce pain and swelling associated with arthritis is regular physical activity.

Change Footwear: Changing footwear can lessen the number of microtrauma joint experiences regularly.

Take NSAIDS: Doctors recommend using non-steroidal anti inflammatory medication. Although this medication does not treat the root cause of the problem, it can relieve pain to some extent.

They also help reduce inflammation on steroid injections site. However, if you are feeling constant severe discomfort in joints, visit your doctor for further consultation.

These treatments measures can enhance the biomechanics of a joint and lower or eliminate the need for additional steroid injections.

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What about Hyaluronic Acid Injections? Is It Worth A Shot?

Doctors describe that majority of the fluid in a healthy knee is hyaluronic acid. However, when you have osteoarthritis of the knee, the hyaluronic acid in your knee decreases. Your doctor can inject additional hyaluronic acid into your intra articular cartilage of the knee to increase the supply.

Studies indicate that hyaluronic acid injections may be more beneficial than other treatments such as painkillers for some osteoarthritis patients. Other studies have demonstrated that they may be as effective as cortisone injections in improving osteoarthritis symptoms such as swelling. Consider the following if you are thinking about receiving a hyaluronic acid intra-articular injection :

Typically, it is not the initial approach. Your doctor may recommend hyaluronic acid if:

Your symptoms are not alleviated by physical therapy, cold, heat, anti inflammatory medication, or painkillers.

You cannot take pain medication such as Tylenol, Aleve, Mortin, or Advil.

A steroid injection is ineffective, or you or your doctor are concerned about its side effects.

HA injections may work in several ways. Hyaluronic acid injections cushion and lubricate the knee’s moving components. This effect has a brief duration. However, the treatment also appears to provide longer-term pain and swelling relief.

You may require more than one injection. In the United States, five types of hyaluronic acid injections are available. Some require only a single injection. Others require up to five injections, typically over the course of 5 or six weeks. If your doctor decide it is necessary, a second steroid shot can be administered after six months.


Steroid injections are used to treat a number of inflammatory diseases or injuries involving the joints or other musculoskeletal structures. In general, they are harmless, although they may have negative effects that impact the injections sites or the entire body.

Therefore, discuss the benefits and drawbacks with your doctor beforehand. There may be other treatments with fewer side effects depending on your condition.


How Long Does A Cortisone Shot Last In The Knee?

Typically, the effects of the steroid injections last up to two months, but can sometimes continue longer. Cortisone shot helps minimize joint-damaging inflammation. Your doctor may also offer other treatments for joint pain arising from ligament or tendon injuries, excess weight, or an autoimmune problem.

How Long Does It Take For A Cortisone Shot In The Knee To Work?

Steroids treatment often takes between 3 and 7 days to begin to exert its beneficial effects in the body. It may take up to two weeks for the corticosteroid medication to reduce inflammation sufficiently to alleviate discomfort. It is possible that the full effect of the cortisone shots will not be felt until six weeks after injection.

What Is The Downside Of A Steroid Injection?

There are risks that frequent administration of steroid injections may cause cartilage damage within a joint. Therefore, doctors limit the amount of cortisone shot into a joint. Cortisone shots should not be administered more frequently than every six weeks and typically no more than three or four times a year.

What are the differences between steroid injections and cortisone injections?

Many individuals are wondering about the distinction between steroid injections and cortisone injections. In the context of orthopedic diseases, both steroid and cortisone injections refer to the same injection substance. Both are effective in relieving pain and reducing inflammation.

What To Expect After Receiving Steroid injection in the knee?

After receiving a injection of steroids, you will immediately notice minor side effects such as swelling and pain in the joint where you received the injection. These symptoms resolve within two days.


  1. Martin SD, Conaway WK, Lei P. Use of Intra-Articular Cortisone shots in Orthopaedics. J Bone Joint Surg Am. 2018 May 16;100(10):885-891. doi: 10.2106/JBJS.17.00289. PubMed PMID: 29762289.
  2. Osteoarthritis Foundation. https://www.arthritis.org/living-with-osteoarthritis/treatments/medication/drug-types/corticosteroids/corticosteroid-injections.php. Accessed July 20, 2019. Joint injections (joint aspirations). American College of Rheumatology.
  3. Use e of Cortisone shots in pain and swelling Osteoarthritis. (https://www. osteoarthritis.org/living-with-arthritis/treatments/medication/drug-types/corticosteroids/corticosteroid-injections.php) Accessed 4/16/2018. American Society for Surgery of the Hand. Steroid Injections.
  4. Bellamy, N., Campbell, J., Welch, V., Gee, T. L., Bourne, R., & Wells, G. A. (2006). Intraarticular cortisone shots for treatment of osteoarthritis of the knee. Cochrane Database of Systematic Reviews, (2).
  5. Arroll, B., & Goodyear-Smith, F. (2004). Corticosteroid injections for osteoarthritis of the knee: a meta-analysis. BMJ328(7444), 869.
  6. da Costa, B. R., Hari, R., & Jüni, P. (2016). Intra-articular corticosterone shots for osteoarthritis of the knee. Jama316(24), 2671-2672.
  7. Jüni, P., Hari, R., Rutjes, A. W., Fischer, R., Silletta, M. G., Reichenbach, S., & da Costa, B. R. (2015). Cortisone shots for knee osteoarthritis. Cochrane Database of Systematic Reviews, (10).
  8. Hepper, C. T., Halvorson, J. J., Duncan, S. T., Gregory, A. J., Dunn, W. R., & Spindler, K. P. (2009). The efficacy and duration of cortisone shots for knee osteoarthritis: a systematic review of level I studies. JAAOS-Journal of the American Academy of Orthopaedic Surgeons17(10), 638-646.
  9. Kullenberg, B., Runesson, R., Tuvhag, R., Olsson, C., & Resch, S. (2004). cortisone shots: pain relief in osteoarthritis of the hip?. The Journal of Rheumatology31(11), 2265-2268.

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