Back Pain Doctor

Cortisone (Corticosteroid) Injection

Cortisone injection is available here and is performed under ultrasound guidance where that improves accuracy. It is used sparingly and for a defined reason, because the short-term relief that makes it attractive is not matched by the longer-term evidence.

What it can help with

  • A clearly inflamed bursa, tendon sheath or joint identified on examination or imaging
  • Pain severe enough to block the rehabilitation that changes the longer-term course
  • A specific, dated short-term goal — a trip, a procedure, a return to work
  • A diagnostic question, where the response tells us where the pain is coming from

Suitability depends on your individual diagnosis and is assessed at consultation.

Cortisone — more precisely, a corticosteroid injection — is one of the most commonly requested musculoskeletal treatments and one of the most commonly misunderstood. It is available here, performed under ultrasound guidance where that improves accuracy, and it is used deliberately rather than routinely.

What cortisone is good at

Reducing pain, over weeks to a few months, where there is an inflammatory target to reduce. A bursa that is genuinely inflamed, a tendon sheath with a tenosynovitis, a small arthritic joint — these are situations where a guided injection has reasonable short-term evidence and where the relief can be worth having in its own right.

It is also useful diagnostically. If a well-placed injection into a specific structure settles the pain, that tells us something about where the pain is coming from. If it does not, that is equally informative, and often more useful than another scan.

What it is not good at

Cortisone does not repair anything. It reduces the inflammatory response and, with it, the pain — but the tendon, the cartilage and the load that produced the problem are unchanged.

That matters because of what the longer-term trials show. In tendinopathy, studies that followed people out to a year found the early advantage of injection had reversed, with worse outcomes than exercise alone. In joints, repeated corticosteroid injections have been associated with cartilage loss.

Neither of those findings makes cortisone a bad treatment. They make it a bad foundation. A plan built on repeated injections tends to postpone the work that actually changes the course, and the pain that keeps coming back is usually telling you something about the diagnosis or the load rather than asking for another injection.

How it is used here

Corticosteroid is reviewed separately from the twelve options in our treatment evidence index. It is an occasional tool with four reasonable uses:

  • pain severe enough to block rehabilitation
  • a clear inflammatory or bursal target on examination or imaging
  • a specific short-term goal — a trip, a procedure, a return to work
  • a diagnostic question, where the response tells us where the pain is coming from

Where one of those applies, we discuss what is being injected and why, keep the number low, and pair it with the loading work that changes the longer-term course. Where none of them applies, we will say so and set out what the alternatives are, which is usually a more useful conversation than the injection would have been.

Where it comes up most

These are the guides on this site that discuss corticosteroid injection as part of the picture. In each case the page states where it fits and where it does not:

bursitis · pes anserine bursitis · greater trochanteric pain syndrome · frozen shoulder · trigger finger · De Quervain tenosynovitis · knee osteoarthritis · wrist arthritis · thumb base osteoarthritis · elbow osteoarthritis · hallux rigidus · patellofemoral arthritis · gout · carpal tunnel syndrome

If you have been offered a cortisone injection elsewhere

Coming in with that question is entirely reasonable and it is a common reason for a consultation. The assessment covers whether the diagnosis fits the structure being targeted, whether an injection is likely to help that structure, what has already been tried, and what the alternatives are — including focused shockwave therapy, PRP, prolotherapy and viscosupplementation, each of which has its own page stating what the evidence does and does not support.

No referral is required to book, and a Medicare rebate applies to the consultation.

How it works

Corticosteroid is a potent anti-inflammatory. Placed close to an inflamed structure it reduces pain and swelling for a period usually measured in weeks to a few months. Where the target is small or deep — a bursa, a tendon sheath, a small joint — ultrasound guidance means the needle can be watched all the way in, rather than the position being inferred from surface landmarks.

What it does not do is repair anything. It reduces the inflammatory response; it does not change the structure of a tendon, restore cartilage, or alter the load that produced the problem. That distinction is the reason it is used the way it is here.

What the evidence shows

Guided corticosteroid injection has good short-term evidence in specific situations — an inflamed bursa, a tenosynovitis, a small arthritic joint — where the aim is to settle pain over weeks. Beyond that window the picture is less comfortable, and it is worth stating plainly rather than leaving to the consultation. In tendinopathy, trials that followed people out to a year found the early advantage of injection reversed, with worse outcomes than exercise alone. In joints, repeated corticosteroid injections have been associated with cartilage loss. Neither finding makes cortisone useless. Both make it a poor foundation for a treatment plan. So it is reviewed separately for each diagnosis: an occasional tool used for one of the reasons above, kept to a low number, and always paired with the loading work that changes the longer-term course.

What to expect

The target is identified by examination and, where relevant, imaging, and the decision to inject at all is discussed first — including what is being injected, how many injections would be reasonable, and what the alternatives are. The injection itself is performed in rooms, under ultrasound guidance where that improves accuracy, and takes a short time. A flare of pain in the first day or two is common before the effect settles in. You will leave with the movement and loading work that the injection is meant to make possible — that part is not optional, because it is the part that changes the longer-term course. The consultation attracts a Medicare rebate and is billed under the time-based GP attendance items; treatment delivered within that consultation is included.

Frequently asked questions

Do you offer cortisone injections?
Yes, and under ultrasound guidance where that improves accuracy. What we do not do is build treatment plans around cortisone. It is used for a defined reason — a clearly inflamed bursa, sheath or joint, pain severe enough to block rehabilitation, a specific short-term goal, or a diagnostic question — and kept to a low number.
Why do you say you use it sparingly?
Because of what happens after the first few months. In tendinopathy, trials followed out to a year found the early advantage of injection reversed, with worse outcomes than exercise alone. In joints, repeated injections have been associated with cartilage loss. Cortisone reduces pain without repairing anything, so it works best as a window that lets rehabilitation happen rather than as the treatment itself.
How long does a cortisone injection last?
Usually weeks to a few months, and it varies with the target and the problem. A shorter-than-expected response is useful information in itself — it often means the pain is not being driven by the structure that was injected, which changes the diagnosis rather than calling for another injection.
How many cortisone injections can I have?
There is no single safe number, and the honest answer is that the question is usually the wrong one. If pain keeps returning to the same place, that generally means the diagnosis or the load needs revisiting rather than repeating the injection. Where repeated injection is being considered, the joint or tendon involved and what has already been given are both part of the discussion.
What if the target is too deep or too risky for ultrasound?
Then it is referred rather than attempted. Some targets — a cervical nerve root or facet joint, an epidural, and some deep spinal and pelvic targets — should be injected under CT, which shows them directly when ultrasound cannot. Where that is the case you are referred to a radiologist to perform the injection under CT guidance. Approximating a deep injection under a modality that cannot see the target properly is both less accurate and less safe.
Does the injection have to be guided by ultrasound?
Not always, but guidance means the needle is watched to the target rather than positioned from surface landmarks, which matters most for small, deep or awkward targets such as a bursa, a tendon sheath or a small joint. Accuracy does not guarantee benefit — the diagnosis, the choice of medication and the aftercare still decide that — but poor placement can reduce the chance of it.
What are the alternatives?
That depends on the diagnosis. For most tendon and joint problems the alternatives are load management and progressive rehabilitation first, with focused shockwave, PRP, prolotherapy or viscosupplementation discussed where they are relevant. Each has its own page setting out what the evidence supports, including where it is weak.
Is cortisone the same as PRP?
No. Cortisone is an anti-inflammatory that reduces pain in the short term. Platelet-rich plasma is a preparation from your own blood, with a different rationale and a different, mixed evidence base that varies by condition. They are sometimes considered for the same problem for different reasons, and the choice is made against the diagnosis.

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