Do you have any information about cortisone shots? I had one in my hip last year. Unfortunately, the pain relief only lasted 10 days, and I ended up having my hip replaced.

My sister Sara has significant osteoarthritis in her hips. Her orthopedic specialist wanted her to make it to 60 years old before she had either hip replaced. He explained to her, “In my experience, people who get the BEST results from a hip replacement have just ONE replacement of that joint during their lifetime. I’ll give you a cortisone injection, which is a potent anti-inflammatory drug. Hopefully, it will give you relief from the pain and stiffness, so we won’t have to do surgery just yet.”

His goal was to keep her moving, delaying the day she had surgery to replace her hip joint as long as reasonably possible. Sara was lucky; her first cortisone injection gave her relief that lasted nearly a year. However, each subsequent shot was less and less effective, causing the pain to return more quickly. Her surgeon guided each anti-inflammatory injection into her hip joint with a continuous X-ray video called fluoroscopy.

Four years later, at age 60, she had surgery to replace her left hip joint. Because she lives alone, I took her to the hospital and then stayed with her for the first 3 days after being discharged home. Her left hip is now fully healed and pain-free. The most common joints for cortisone injections are the knee, hip, wrist, and shoulder.

Repetitive movements can cause irritation and inflammation in your shoulder, elbow, knee, hip, and wrist. Redness, swelling, and tenderness can occur in tendons or little fluid-filled sacks near joints called bursa. Rest is the best treatment. If that doesn’t help, injecting the affected area with a corticosteroid can help relieve pain and swelling. Activities like sports, jobs, or hobbies involving frequent, repetitive movements may need to be reduced or modified for longterm relief to succeed.

Other joint conditions that can be helped with cortisone injections include gout, rheumatoid arthritis, and osteoarthritis, like my sister’s hip. Not all cortisone injections need X-ray imaging to guide them. Some joints are closer to the surface, allowing a physician to locate landmarks by touch. Other joints with more tissue covering them need to be visualized by x-ray or ultrasound to ensure that the needle is correctly positioned. Most people getting a cortisone injection for an inflammatory condition will notice relief after one injection.

If there isn’t any improvement, more evaluation is needed to figure out what is causing the problem. With cortisone injections, more is not always better. Although they relieve pain and swelling, repeated injections with potent antiinflammatory agents may weaken tendons and ligaments. These medications can also accelerate age-related changes in cartilage in the joint.

Although an injection gives joints, bursa, or tendons concentrated medicine, eventually your body has to remove it, with the cortisone ending up in your bloodstream. This can cause blood sugar in diabetics to increase, usually in the week following a steroid injection. I have noticed temporary increases in the blood thinner level of people taking warfarin for 1-2 weeks after having an injection of cortisone. Most physicians advise taking it easy for several days immediately after a steroid shot.

Having a high concentration of anti-inflammatory medicine in your joint can increase the chance of injuring or tearing the surrounding tissue. It’s common to experience some tenderness at the injection site following a cortisone shot. Taking antiinflammatory pills for the first 24-48 hours can help reduce tenderness around the area. Naproxen 220mg tablets (Aleve®) or ibuprofen 200mg (Motrin IB®) are options that do not require a prescription. Applying ice soon after your injection can reduce discomfort. If you notice significant swelling or develop chills or fever, contact the doctor right away.

Although infection is unlikely, it can happen. Here’s how to apply ice for maximum benefit: 1. Use a THIN clean dish towel, preferably one that is woven. Thick towels with loops don’t work as well. 2. Wet the dishtowel, then wring it out so that it is damp but no longer wet. You don’t want it dripping. 3. NEVER use ice on bare skin. It can cause frostbite. 4. Cover the inflamed area with the damp towel, then put your ice on top. Individual ice cubes, ice packs, frozen gel packs, even bags of frozen peas or corn will work. 5. Apply the ice for 15 minutes at a time, then remove it. Repeat every 1-2 hours as needed.

Dr. Louise Achey, Doctor of Pharmacy, is a 42-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Get clear answers to your medication questions at her website and blog TheMedicationInsider.com.® 2021 Louise Achey