WHAT IS CORTISONE?
How is cortisone effective?
How many injections are needed?
What are the different types of injections?
Articular or joint injections are preceded by an aspiration (withdrawing joint fluid or blood). Joints commonly injected are the shoulder, knee, ankle, and small joints of the hand and foot. Most injections can be followed by a booster injection two to four weeks later. A good limit is three injections over a three-month period of time at a single location (an injection to another location can be done at any time).
A “trigger point” injection is an injection in the soft tissue or myofascial structures of the body. Injections can also be performed at the insertion of a tendon area or into the bursa surrounding such joints as the shoulder, knee, or the hip.
An epidural steroid injection is another category of cortisone injection. It is neither a joint nor “trigger point” injection, but rather an injection inside the bony column of the spine surrounding the dura (the sac that encloses the spinal cord and spinal nerves). Lumbar epidural injections involve a relatively simple technique. They are done several inches from the spinal cord and are unlikely to be accompanied by complications, except perhaps a headache. Cervical (neck) epidural injections are similar to lumbar epidural injections except there are additional risks associated with this area of the body. Epidural steroid injections are useful for a variety of back conditions including sciatica, arthritis, degenerative disc problems, and spinal stenosis. All spinal injections should be performed with the use of an x-ray C-arm machine.
Is the injection painful?
It has been Dr. Suthar’s experience and approach that most injections can be performed with very little pain. By adhering to proper precautions and using analgesics the discomfort of injections can be greatly reduced. What one experiences as “pain” during the injections is also variable and often not related to pain but more to anxiety of the unknown. Injections into an area that is already inflamed are more sensitive and can therefore create some discomfort that typically lasts only a few seconds. Some areas, such as the hand and foot, are particularly sensitive and a freeze block is used before the injection. Other areas, such as the knee and shoulder, are much better tolerated, and many patients hardly feel anything.
Cortisone shots are generally accompanied by an anesthetic such as Marcaine or Lidocaine. This deadens the area and surrounding tissues where the shot should be placed (the pain will go away over about 2-3 hours while the anesthetic works). Most people who have reactions or allergies to cortisone rarely have the reaction to the anesthetic agent of the epinephrine (adrenaline), which may be contained in some forms of the injection. Epinephrine can cause tachycardia (rapid heartbeat) in some patients. For others, the sight of a needle will cause this reaction, and the feeling of being faint is often misinterpreted as an allergic reaction.
13710 Olive Boulevard (Primary Office)
Chesterfield, MO 63017
Telephone: 314-469-PAIN (7246)
Exchange: 314-441-6965 (for after-hour Emergencies Only)
Monday thru Friday
8:30 AM – 4:30 PM