Cortisone injections are a powerful and effective treatment for localized inflammation and pain, but they are not suitable for everyone. A physician must carefully evaluate a patient's medical history before administering this treatment to ensure safety and prevent potential complications. In some cases, the risks far outweigh the benefits, making the injection a contraindicated therapy.
Contraindications Related to Infections
One of the most critical contraindications for cortisone injections is the presence of an active infection. Corticosteroids, including cortisone, have a temporary immunosuppressant effect that can hinder the body's ability to fight off a bacterial, viral, or fungal infection. Administering the injection during an active infection can lead to serious and potentially life-threatening complications.
Local and Systemic Infections
- Local infection: An infection at or near the intended injection site is a clear red flag. This could include cellulitis, an open wound, or a suspected joint infection (septic arthritis). Injecting a steroid into an already infected area can spread the infection deeper into the joint or surrounding tissues.
- Systemic infection: If a patient has a body-wide infection, such as sepsis, bacteremia, or an active infection elsewhere in the body (e.g., a chest infection or urinary tract infection), a cortisone injection should not be administered. The temporary suppression of the immune system could worsen the systemic illness.
- Recent exposure: Patients who have recently been in contact with someone who has a contagious illness like chickenpox or measles may need to postpone their injection, especially if they have not previously had these illnesses.
Chronic Health Conditions and Cortisone Injections
Several long-term health issues can influence a patient's eligibility for cortisone injections. The systemic effects of corticosteroids, even when injected locally, can exacerbate certain conditions.
Diabetes
Cortisone is known to raise blood sugar levels, an effect that can last for several days after the injection. For patients with poorly controlled diabetes, this spike can be dangerous and difficult to manage. Therefore, a doctor may advise a patient to wait until their blood sugar is under better control before proceeding.
Bleeding Disorders and Anticoagulant Use
People with bleeding disorders like hemophilia or those taking anticoagulant medications (blood thinners) face a higher risk of bleeding and bruising at the injection site. Some blood thinners, such as warfarin, may need to be temporarily stopped before the procedure, but this should only be done under a doctor's strict guidance.
Weakened Bones and Tendons
Repeated or improperly placed injections can weaken bones and tendons, potentially leading to osteoporosis or tendon rupture. This is a particular concern for vulnerable areas, such as the Achilles and patellar tendons, and in patients with pre-existing osteoporosis.
Other Concerns
- Congestive heart failure: Patients with this condition may be at higher risk for complications due to the fluid retention that can sometimes occur with steroid use.
- Kidney or liver disease: Impaired organ function can affect how the body processes and eliminates the medication, increasing the risk of adverse effects.
- Glaucoma: Some eye problems, including glaucoma, may be worsened by corticosteroid use.
- Mental health issues: A personal or family history of severe depression or manic depression (bipolar disorder) may be a contraindication, as steroids can sometimes cause mood changes.
Traumatic Injuries, Surgery, and Injections
Timing is a critical factor for cortisone injections, especially in the context of injuries and surgical procedures.
Recent Fractures
For a recent bone fracture, a cortisone shot is generally not recommended in the affected area. The steroid can inhibit the healing process, delaying recovery and potentially compromising the bone's repair.
Planned Surgery
Patients planning to undergo surgery, particularly joint replacement, must inform their doctor about recent cortisone injections. Having a shot within a few months of surgery can increase the risk of infection and negatively impact wound healing and overall outcomes.
Masking Serious Spinal Conditions
Injections for spinal conditions should be approached with caution, particularly if there are serious neurological symptoms like numbness or weakness. A cortisone injection could mask these symptoms, potentially delaying the diagnosis and treatment of a more severe underlying issue that may require surgery.
Comparison of Contraindications
| Condition / Factor | Absolute Contraindication (Typically a Hard 'No') | Relative Contraindication (Needs careful consideration) |
|---|---|---|
| Infection | Active local or systemic infection | Recent exposure to highly contagious illness |
| Bleeding | Severe bleeding disorder (e.g., hemophilia) | Taking certain anticoagulants (consultation needed) |
| Diabetes | Uncontrolled or poorly managed blood sugar | Controlled diabetes (requires close monitoring) |
| Trauma | Recent bone fracture at the injection site | Tendon injury (Achilles, patellar) |
| Surgery | Upcoming joint replacement surgery (within 3 months) | Any surgery where injection might interfere with healing |
| Allergies | Known hypersensitivity to cortisone or preservatives | None |
| Pregnancy | Not typically absolute, but requires thorough doctor consultation | Breastfeeding |
| Infection Risk | Joint prosthesis | Immunosuppressed patients |
Other Considerations and Limitations
It is also important to note that the number of cortisone injections into a single area is limited. Healthcare providers generally recommend no more than three to four injections per year in the same joint to prevent long-term damage to articular cartilage and soft tissues. Furthermore, patients who receive little or no benefit from an initial injection may be advised against further treatments.
Finally, for many musculoskeletal issues, alternative treatments may be more appropriate or preferred. Patients should always have an open discussion with their healthcare provider about all available options, including physical therapy, oral medications, and lifestyle changes.
Conclusion
While cortisone injections offer significant relief for inflammatory conditions, a number of factors can make a patient ineligible for the treatment. The primary concern is the potential for infection, but chronic conditions like diabetes and specific situations like recent fractures or upcoming surgery are also major considerations. As with any medical procedure, an individualized assessment of risks and benefits is essential. Patients should provide a complete and honest medical history to their doctor to ensure a safe and effective treatment plan. For more detailed information on steroid injections and their effects, resources like the MedlinePlus drug information page provide a valuable starting point.
