Ask the Doc: What Is a Cortisone or Steroid Injection?

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by NICHOLE BLUEMLE|PT, DPT, MS, OCS, CSCS

Cortisone Injections

Ask the Doc: What Is a Cortisone or Steroid Injection?

Cortisone injections alone are not pain-relieving medications, although sometimes pain relief is a byproduct of the decrease in inflammation
Cortisone is a hormone that is naturally produced in the body by the adrenal gland and released into the bloodstream for a brief anti-inflammatory effect in response to stress. A cortisone injection (also called steroid or corticosteroid injection) is when a synthetic form of cortisone (e.g., Celestone, Kenalog) is administered locally to a specific area of suspected or confirmed inflammation via hypodermic needle and is designed to be much more potent and longer lasting than naturally occurring cortisone. Cortisone injections alone are not pain-relieving medications, although sometimes pain relief is a byproduct of the decrease in inflammation and associated decreased perceived threat of tissue damage to the brain. In addition to the cortisone, a local anesthetic (e.g.. Lidocaine, Marcain) may be administered first to numb the injection site and/or combined in solution with the cortisone and injected into the joint or tissue. Primarily, the anesthetic is intended to make the injection less painful, as it is short lasting (4-18hrs). An injection can be used for therapeutic purposes (treat inflammation) and/or diagnostic value (used to confirm or rule out a specific structure as a source of inflammation/pain based on patient response). Common musculoskeletal conditions in which cortisone injection may be appropriate in the right situation include tendonitis, bursitis, and arthritis.

Epidural Steroid Injection

An epidural steroid injection (ESI) is when a corticosteroid (e.g., triamcinolone, betamethasone) is injected into the epidural space of the spine to target an inflamed spinal nerve root.
ESI is most appropriate for chronic leg or arm radicular symptoms (pain, numbness, tingling) associated with spinal nerve root inflammation and compression from disc herniation, spinal stenosis, or spondylolysis. [For a description of these terms, check out our previous article: Back pain and the terms that aren't as scary as they sound.] Usually ESI is reserved for chronic radicular symptoms that have not improved with conservative management. An oral corticosteroid (e.g., Depo-Medrol, Medrol, methylprednisolone) may be administered for severe symptoms associated with acute disc herniation.

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