Cortisone Injections: What You Need to Know

Welcome to another edition of the Doctor’s Note where we talk about what’s on our minds when it comes to your health.

This week I sat down with our Bristol provider, Jill Henritze, PA-C (orthopedics expert), to talk about cortisone injections for joint pain—an old but trusted tool we still use regularly. Using my own pickleball paddle as a springboard, we talked about how the sport’s popularity—especially among the over 40 crowd—has led to a fair share of joint trouble. Yes, cortisone injections (when used thoughtfully) can offer true relief and help folks stay active, but there’s a right way and a right time to use them.

Jill and I covered when to consider a cortisone injection, what results you can realistically expect, how often you should get them in any one joint, and important caveats about where they shouldn’t be used. We didn’t shy away from discussing possible side effects and why REST after an injection is key. Our goal here was to combine orthopedic know-how with common sense, so you can get back to the activities you love—safely and with less pain.

PODCAST NOTES 

• Cortisone Shots Can Still Work Wonders. For arthritis or chronic inflammation, cortisone injections can make a world of difference. They’re great at dialing down inflammation, which relieves pain—sometimes dramatically—and buys you months of comfort. But their magic depends on getting the diagnosis right. Note: they aren’t meant for every ache or sprain.

• Who Should Consider a Cortisone Shot? If you’ve got arthritis causing regular pain, or tendonitis that hasn’t budged with rest or rehab, you’re likely a good candidate. Sometimes even younger patients with stubborn tendon issues can benefit. But if it’s a brand-new injury or you’ve got major swelling, it’s better to investigate first—sometimes with imaging—before considering an injection.

• Don’t Overdo It. I can’t stress this enough—no more than four cortisone shots per joint per year, and never more frequently than once every three months. Overuse can actually break down cartilage and worsen joint health down the line. Folks with diabetes or other complicating health problems may need even fewer.

• Choosing the Right Steroid and Dose Matters. In my practice, I most often use Kenalog or Depo-Medrol for joints, adjusting the dose depending on whether I’m treating a big knee or a small finger. Tailoring the choice and amount helps minimize side effects and maximize relief, without overwhelming the joint.

• Some Places Are Off Limits for Steroid Injections. You don’t want to inject cortisone into every sore spot. The Achilles tendon and plantar fascia are especially risky, as repeated steroids can weaken and actually rupture these structures. Same goes for the spine—leave those to specialists with imaging guidance.

• Risks, Side Effects, and Mixing in Lidocaine. While generally safe, cortisone shots aren’t risk-free. Infection is rare but possible, so sterile technique is a must. I usually mix a local anesthetic like lidocaine in with the steroid—it offers immediate numbness, helps confirm we’re in the right spot, and sometimes aids in diagnosis. Rarely, patients get a temporary pain spike right after the shot (“post-injection flare”), but it passes.

• Relief Takes Some Time (and Sometimes Gets Worse Before It’s Better). Most folks notice improvement in a day or two, though it may take up to three days, especially in larger joints. Sometimes the area aches more before it gets better—this is normal. Real relief usually sets in within a week, and for many, continues to build over several weeks.

• Rest is Critical After Injection. Don’t rush back to pickleball or jogging the day of your shot! I recommend folks take it easy for at least three to five days, sometimes up to a week, especially if we’re treating an acute tendon or ligament injury. Let the medication do its job and slowly ramp up your activity so you don’t set yourself back.

In summary, cortisone injections are a valuable option for those struggling with joint pain—especially when used wisely, sparingly, and as part of an overall plan. If you’re frustrated with joint pain that’s keeping you off the court or out of your routine, don’t ignore it and don’t tough it out alone. Give us a call or talk to your provider about whether a cortisone shot, or another treatment, might get you moving again.

And as always—whether it’s pickleball, tennis, or just your morning walk—don’t forget to warm up, use those dynamic stretches, and stay smart about what your body can handle. Take care of those joints, and keep moving!

Stay educated. Stay healthy. 

Till next week.