Cortisone and Corticosteroid Injections Info Evidence

What it is

A cortisone injection is a shot of strong anti-inflammatory medicine, called a corticosteroid, into a painful joint or tendon. The medicine calms swelling and eases pain in one spot. It is not a painkiller you take by mouth. It works where it is placed.

Your doctor may offer this treatment for several hand, wrist, elbow and shoulder problems. These include trigger finger (a finger that catches or locks), carpal tunnel syndrome (pressure on a nerve at the wrist), tennis elbow, thumb base arthritis, frozen shoulder and some ganglion cysts. It can also be used after some shoulder operations, though usually not in the first month after surgery [1].

The injection does not fix the underlying problem. It buys relief while your body heals, or while you do exercises or wear a splint. For carpal tunnel syndrome, for example, it can ease symptoms for a while, but most people eventually need surgery for lasting control [2]. For tennis elbow, the short-term relief can fade, and problems often come back later [3]. Your doctor will talk with you about whether an injection fits your situation, or whether another option such as exercise, splinting or surgery makes more sense first.

Does it work?

The honest answer is: it depends on the condition being treated.

For some problems, injections work well. For frozen shoulder, a steroid injection into the joint eases pain, improves how the shoulder works and increases range of motion [4]. For de Quervain disease (swelling of the tendons at the base of the thumb), pain and clinical outcomes improved significantly after injection [5]. For thumb base arthritis, steroids are a favourable option because they are easy to give and work well [6], though the benefit may be short term [7].

For other problems, the picture is more mixed. For tennis elbow, steroid injections can bring short-term relief, but that relief is often reversed after six weeks, and the problem frequently comes back [3]. Research suggests steroids should not be used for most people who have had tennis elbow symptoms for less than 12 months [8]. For carpal tunnel syndrome, injections give safe, effective relief for a while, but most people eventually need surgery for lasting control [2].

Some findings are worth knowing before you choose this treatment. For trigger finger, one steroid type (betamethasone) failed sooner than another (triamcinolone) [9]. For rotator cuff repair, there were no clear signs that a steroid injection raises the risk of the repair failing again or of infection [10]. A single injection before rotator cuff surgery, given within 1 year of the operation, did not change failure rates, patient-reported outcomes, range of motion or strength [11].

The evidence is not perfect. Some of these findings come from small trials or reviews, and a few conditions have limited research to draw on. Your doctor will weigh the evidence for your specific condition and talk with you about whether an injection is likely to help you, or whether another option makes more sense first.

What are the risks?

Most people notice only short-term effects at the injection site. The shot itself can hurt, and adding a numbing medicine (lidocaine) to the steroid changes how much pain you feel during and just after the injection [12]. That difference may not matter much in the long run, but it is worth asking about before your injection.

The steroid can also affect the tissue where it is placed. For tennis elbow, research links steroid injections with calcium building up in the soft tissue, and this is likely a complication of the injection itself [13]. For some people treated for tennis elbow, a single steroid injection led to poorer long-term results and the problem coming back more often 1 year later [14].

The medicine can reach beyond the spot where it was injected. If you have type 2 diabetes and do not use insulin, a shoulder steroid injection can raise your blood sugar levels for a short time [15]. If you have diabetes and are having treatment for de Quervain disease, a single injection is less likely to work for you than for people without diabetes, though further injections do not seem to lose their effect [16].

Some risks you might worry about have been studied and were not found. After rotator cuff repair, studies found no clear evidence that a steroid injection raises the risk of the repair tearing again or of infection [10]. A steroid injection before carpal tunnel release surgery was not linked to a higher rate of deep infection afterwards [17]. Repeated injections for carpal tunnel syndrome were found to be safe, and they did not make later surgery riskier [18].

How often an injection can be given matters too. For trigger finger, one study found no complications when a 4 mg triamcinolone injection was given at intervals of at least 1 month [19]. For de Quervain disease, an injection aimed at one tendon compartment can lower the steroid dose used, which may reduce complications [20].

Is it right for you?

An injection may suit you if your pain comes from one clear spot, such as a trigger finger, thumb base arthritis or a frozen shoulder. For thumb base arthritis (wear-and-tear arthritis at the base of the thumb), research favours steroid injections because they are easy to give and work well [6]. If you have carpal tunnel syndrome and other injections have not lasted, repeat injections have been found safe, and they did not make later surgery riskier [18].

An injection may not suit you if your tennis elbow symptoms have lasted less than 12 months. Research suggests steroids should not be used for most people in that situation [8]. For tennis elbow generally, platelet-rich plasma (a treatment made from your own blood) beat steroid injections at the 6 month mark, while steroids worked better in the first month [21].

The choice is one you make together with your doctor. They will look at your condition, your symptoms and what you have already tried. Ask what the injection is meant to achieve, how long relief might last, and whether exercises, a splint or surgery would serve you better. The risks section above covers side effects in detail, so read that before you decide.

The bottom line

A cortisone injection can be worth considering for a clear, one-spot problem such as a frozen shoulder, de Quervain disease or thumb base arthritis. Expect relief that may be real but often short term, and know that for some conditions, such as tennis elbow or carpal tunnel syndrome, other treatments or surgery may serve you better in the long run. The single most important caveat: an injection eases symptoms, it does not fix the underlying problem.

Cortisone and Corticosteroid Injections Info Evidence

What it is

Does it work?

What are the risks?

Is it right for you?

The bottom line

Overview

Efficacy by Condition

Steroid Type and Dosing

Safety and Timing

Contraindications

How It Works

Efficacy and Outcomes by Condition

Steroid Type and Dosing

Safety and Complications

Timing and Surgical Context

Contraindications and Cautions

What the Evidence Shows

Trigger Finger

Lateral Epicondylitis (Tennis Elbow)

Rotator Cuff

Shoulder (General)

Carpal Tunnel Syndrome

Thumb Carpometacarpal Joint

Plantar Fasciopathy

Practical Considerations

Steroid Selection and Dosing

Timing and Frequency

Efficacy and Outcomes

Safety and Complications

Imaging Guidance

Key Evidence

References