Cortisone shots are a common and effective medical treatment used to reduce inflammation and relieve pain in specific areas of the body, such as joints, tendons, and bursae. While generally safe, this powerful corticosteroid is not suitable for everyone or every situation. Patients must understand the specific scenarios where a cortisone injection could be harmful and discuss these risks thoroughly with their healthcare provider.
Absolute Contraindications: Clear Reasons to Avoid a Shot
Certain conditions make receiving a cortisone shot unsafe and can lead to serious health complications. These are considered absolute contraindications, meaning the injection should not be administered under any circumstances.
Active Infections
Cortisone is an immunosuppressant, meaning it can weaken the body's immune response. For this reason, a cortisone shot must be avoided if there is an active infection, whether it is localized at the injection site or systemic throughout the body. Injecting into or near an infected area can spread the infection or make it harder for the body to fight off, potentially leading to septic arthritis or other severe complications. Signs of an infection can include fever, spreading redness, worsening pain, or pus near the injection site.
Poorly Controlled Diabetes
Cortisone is known to raise blood sugar levels temporarily, an effect that can last for several days after the injection. For individuals with poorly controlled diabetes, this temporary spike can be dangerous and difficult to manage. While those with well-managed diabetes may still receive the shot with careful monitoring, a doctor will likely advise waiting if your blood sugar is not well-controlled. This is especially true for insulin-dependent individuals who need a plan to manage their glucose levels during this period.
Upcoming Surgery
Receiving a cortisone injection too close to a planned surgical procedure can negatively impact the outcome. The anti-inflammatory effects of cortisone can interfere with wound healing and the body's natural inflammatory response necessary for recovery. A typical recommendation is to wait at least three months between a cortisone shot and surgery on the same joint, such as a knee or hip replacement.
Bleeding Disorders or Anticoagulant Use
Individuals with a bleeding disorder, such as hemophilia, or those taking blood-thinning medication (anticoagulants) have an increased risk of bleeding and bruising from any injection. A doctor must evaluate this risk carefully before proceeding with a cortisone shot. In many cases, it may be necessary to temporarily stop anticoagulant medication, which should only be done under strict medical supervision.
Relative Contraindications and Conditions Requiring Caution
Beyond the absolute contraindications, several other conditions or circumstances warrant careful consideration and may make a cortisone shot a less desirable option.
Repeated Injections in the Same Joint
While a single cortisone shot can be highly beneficial, repeated injections into the same joint are a concern. Frequent shots, often limited to three or four per year in the same area, can contribute to cartilage thinning and joint damage over time. In some cases, studies suggest that cortisone injections into the knee and hip joints may accelerate osteoarthritis progression.
Certain Tendon Injuries
Injecting cortisone directly into certain tendons, particularly the Achilles or patella tendons, can weaken them and increase the risk of a tendon rupture. For this reason, many physicians will avoid cortisone injections for these specific tendon injuries, opting instead to inject near the tendon or explore alternatives.
Recent Fractures and Severe Injuries
In general, cortisone shots are not recommended for areas with a recent bone fracture, as they can slow healing. Similarly, if a spine injury causes severe numbness or weakness, a cortisone injection might be held off. By masking the pain, the shot could obscure symptoms that might signal the condition is worsening and requires surgery.
Cortisone vs. Alternative Treatments: A Comparison
For patients who cannot receive a cortisone shot or who want a more long-term solution, several alternatives exist. The following table compares cortisone injections with one prominent alternative, Platelet-Rich Plasma (PRP) therapy.
| Feature | Cortisone Shot | Platelet-Rich Plasma (PRP) Therapy |
|---|---|---|
| Mechanism | Anti-inflammatory steroid that suppresses the immune response. | Uses a concentration of the patient's own platelets and growth factors to promote healing. |
| Speed of Relief | Often provides rapid, temporary relief within days. | Slower onset of relief as it relies on natural healing processes. |
| Duration of Effect | Weeks to a few months; relief is not permanent. | Potential for more sustained, long-term improvement as it promotes healing. |
| Healing Properties | Primarily masks pain and reduces inflammation, but does not promote tissue repair. | Stimulates tissue regeneration and repair. |
| Risks | Cartilage damage, tendon weakening, blood sugar spikes, infection. | Reduced risk of side effects since it's from the patient's own body. |
| Best For | Acute, severe inflammation needing immediate, short-term relief. | Chronic pain where tissue healing is needed, offering a more long-term solution. |
Alternatives to Cortisone Shots
When a cortisone shot is not appropriate, other options can provide significant relief. These include:
- Physical Therapy: Tailored exercises and stretches can strengthen the surrounding muscles, improve joint stability, and reduce pain without injections.
- Platelet-Rich Plasma (PRP) Therapy: As detailed above, PRP is a regenerative medicine technique that uses the body's own healing properties. It is often a safer, less invasive alternative for conditions requiring tissue repair.
- Topical Pain Medications: Gels, creams, or patches can provide localized pain relief with fewer systemic side effects.
- Oral Medications: For less severe cases, your doctor may suggest oral anti-inflammatories or other pain relievers.
- Lifestyle Changes: Weight loss, supportive footwear, and activity modification can significantly reduce stress on affected joints.
Conclusion: The Importance of Clinical Judgment
A cortisone shot is a powerful tool for managing inflammation and pain, but it is not a cure-all. Healthcare providers must carefully evaluate a patient's full medical history and current condition before recommending this treatment. Knowing when should you not get a cortisone shot is the first step toward exploring safer and more effective alternatives that support long-term health and healing. Ultimately, the decision to proceed with a cortisone injection should be a collaborative one between you and your doctor, weighing the potential benefits against the risks and considering all available treatment options.
For additional information on corticosteroids, consult the official resources provided by the Mayo Clinic: Prednisone and other corticosteroids: Balance the risks and benefits.
