Cortisone injection side effects
Pro Research Analysisby 
Searched over 200M research papers
Cortisone Injection Side Effects
Cortisone injections, commonly used for their anti-inflammatory properties, are a prevalent treatment for various musculoskeletal conditions. However, they come with a range of potential side effects, both local and systemic. This article synthesizes the findings from multiple research studies to provide a comprehensive overview of these side effects.
Local Side Effects of Cortisone Injections
Steroid Flares and Crystallization
One of the immediate local side effects of cortisone injections is the occurrence of "steroid flares," which are painful reactions caused by the crystallization of cortisone at the injection site. Research using molecular dynamics simulations and X-ray diffraction has shown that cortisone can partition into lipid bilayers and crystallize, particularly at higher concentrations, leading to these painful flares .
Skin and Soft Tissue Reactions
Cortisone injections can also cause various skin and soft tissue reactions. These include local skin atrophy, hypopigmentation, and skin defects. In some cases, more severe reactions such as cellulitis, ecchymosis, and even necrotizing fasciitis have been reported. Tendon ruptures and atrophy of the plantar fat pad are other significant adverse effects associated with these injections .
Systemic Side Effects of Cortisone Injections
Hypothalamic-Pituitary-Adrenal (HPA) Axis Suppression
Systemic effects of cortisone injections often involve the suppression of the hypothalamic-pituitary-adrenal (HPA) axis. Studies have shown that serum cortisol levels can decrease within hours of the injection, with a nadir occurring 24-48 hours post-injection. Recovery to baseline cortisol levels can take anywhere from 1 to 4 weeks, depending on the type and dose of the corticosteroid used .
Metabolic and Hematologic Effects
Cortisone injections can lead to transient increases in blood glucose levels, particularly in diabetic patients. These levels can peak around 300 mg% and last for a few days. Additionally, cortisone injections are associated with reductions in inflammatory markers such as C-reactive protein and erythrocyte sedimentation rate, which can last for months. Other reported systemic effects include changes in inflammatory cytokines, metabolic disturbances, and hematologic alterations .
Osteonecrosis and Joint Damage
Long-term or high-dosage cortisone therapy has been linked to severe skeletal changes, including osteoporosis and avascular necrosis of the femoral and humeral heads. These conditions can lead to significant joint damage and are often irreversible. Cases of rapid and severe hip-joint arthropathy have also been documented, highlighting the potential for serious joint deterioration .
Conclusion
While cortisone injections are effective for reducing inflammation and pain, they come with a range of potential side effects. Local reactions such as steroid flares, skin atrophy, and tendon ruptures are common, while systemic effects can include HPA axis suppression, metabolic changes, and even severe joint damage. Patients and healthcare providers should weigh these risks against the benefits when considering cortisone injections for treatment.
Sources and full results
Most relevant research papers on this topic