A cortisone injection is a common medical procedure used to deliver a powerful anti-inflammatory corticosteroid directly into a specific area, such as a joint, bursa, or tendon sheath. While the goal is to provide localized pain relief, the medication can cause a range of side effects that manifest on different timelines. Understanding when to expect these effects, from the immediate and common to the rare and delayed, is crucial for anyone undergoing this treatment. Side effects depend on factors like the injection site, the dosage, the individual's overall health, and the frequency of injections.
Immediate and Short-Term Side Effects (Within Hours to Days)
Many of the most common side effects of a cortisone shot appear shortly after the injection and are typically temporary. These are often localized to the injection site but can also include broader systemic reactions.
- Cortisone or Steroid Flare: This is one of the most common immediate side effects, where the treated area experiences a temporary increase in pain and inflammation. It is thought to occur as the cortisone crystals are deposited in the joint. The discomfort usually begins within the first 24 hours and typically resolves on its own within two to three days. Rest and applying ice can help manage the symptoms during this time.
- Bruising and Localized Pain: It's normal to have some soreness, bruising, or swelling around the injection site. This is a minor effect from the needle insertion and generally subsides within a few days. Applying an ice pack can reduce discomfort.
- Facial Flushing: Some people report a feeling of warmth and a reddish appearance on their face and chest. This is a harmless side effect that usually lasts for a few days.
- Temporary Blood Sugar Spike: For individuals with diabetes, a cortisone shot can cause a temporary rise in blood sugar levels. This effect can last for several days, and patients with diabetes should monitor their blood glucose closely and have a management plan from their doctor.
- Insomnia and Mood Swings: Corticosteroids can affect mood and sleep patterns. Some individuals may experience heightened energy, anxiety, or insomnia, which can last for 1 to 3 days. Scheduling the injection earlier in the day may help mitigate sleep disturbances.
- Weakness or Numbness: If a local anesthetic was used, temporary numbness or weakness in the affected limb is common. This effect is brief, typically lasting only a few hours.
Less Common and Delayed Side Effects (Weeks to Months)
While most side effects are short-lived, a few are more delayed and may signal a need for medical follow-up.
- Skin Changes: Over several weeks or months, a small percentage of individuals may notice skin thinning (atrophy) or lightening (hypopigmentation) at the injection site. These effects are more common with superficial injections and often improve over a year but can sometimes be permanent.
- Tendon Weakening and Damage: Injecting cortisone too frequently into a tendon can weaken it, increasing the risk of rupture. This is a primary reason why doctors limit the number of cortisone shots a person receives in a specific area per year.
- Menstrual Changes: Rare but possible, some individuals may experience changes to their menstrual cycle, including longer or heavier periods, within days to weeks of the injection.
- Adrenal Suppression: Cortisone mimics the body's natural cortisol. In rare cases, especially with frequent injections, the body's adrenal glands may temporarily reduce their natural cortisol production. This can cause fatigue, weight loss, and muscle pain, but the effects usually improve within a few weeks as the medication wears off.
Rare, Severe, and Long-Term Side Effects
Certain severe side effects are rare and primarily associated with high doses or frequent, long-term use.
- Infection: A serious but very rare risk is an infection in the joint, known as septic arthritis. Symptoms include intense pain, fever, redness, and swelling that get worse after the initial injection period. This requires immediate medical attention.
- Cartilage Damage and Bone Loss: Excessive or frequent cortisone injections can potentially damage cartilage and lead to bone density reduction over time, which can contribute to avascular necrosis (bone tissue death).
- Anaphylaxis: In very rare cases, a serious allergic reaction can occur immediately after the injection. Signs include swelling of the face, tongue, or throat and difficulty breathing.
Comparison of Common vs. Rare Cortisone Shot Side Effects
| Feature | Common/Short-Term Side Effects | Rare/Long-Term Side Effects |
|---|---|---|
| Onset | Hours to days after injection | Weeks, months, or after repeat injections |
| Duration | Typically a few days to a week | Can be permanent (skin changes) or last for months |
| Severity | Mild to moderate; typically self-resolving | Can be severe and require immediate medical care (e.g., infection) |
| Affected Area | Injection site, face, mood, sleep | Skin, tendons, bones, adrenal glands |
| Associated Factors | Normal physiological response to medication | High dose, frequent use, individual predisposition |
| Management | Rest, ice, over-the-counter painkillers | Medical intervention, potential surgery |
Conclusion
The timeline for side effects after a cortisone shot is varied, with most people experiencing only immediate, minor issues that resolve within a few days. The most common immediate effect is a temporary increase in pain known as a cortisone flare, lasting a couple of days. Systemic effects like insomnia or facial flushing may also occur in the short term, resolving within a week. While rare, more significant and delayed side effects, such as skin changes or tendon weakness, are typically associated with frequent or high-dose injections. Severe issues like joint infection are very uncommon but require immediate medical attention if symptoms arise. By understanding this timeline, patients can better manage their recovery and know when it is appropriate to consult their healthcare provider about any unusual or persistent symptoms.
For more detailed information on steroid injections and their use, refer to the resources provided by reputable health organizations like the Mayo Clinic.
