Do I Need an Ultrasound Guided Cortisone Injection?

Cortisone injections or steroid injections are a simple and popular way to treat musculoskeletal problems such as pain in the knees or hip. If you’re considering a cortisone injection or have been recommended for a steroid injection by your GP or health practitioner, this article will help you understand the pros and cons of cortisone injections, what it involves, and why it may or may not be the right course of action for you.

What is a cortisone injection?

The term ‘cortisone injection’ is a generic term that is popularly used for a wide range of corticosteroid injections. In fact in modern medicine cortisone itself is rarely used as there are many more effective and longer lasting compounds available, but the term ‘cortisone injection’ has stuck.

In any case, the treatment involves a medical practitioner – such as a doctor or physiotherapist – injecting a painful area of the body with a steroid in order to reduce pain and help the body to heal.

Ultrasound guidance is recommended by medical research as visualization of the needle increases the accuracy and reduces the risk of complications.

What does a cortisone injection do?

When steroid injections are used for musculoskeletal issues it is in order to reduce inflammation, and in turn reduce pain. This might be an inflamed joint, such as in the case of arthritis, or soft tissue inflammation, such as with tendonitis or bursitis.

The reduction in inflammation of the joint or tissue reduces pain and increases mobility. This may allow you a crucial respite from your pain and allow you to get back to normal activities such as work and home life, or sleeping.

It also provides a pain-free window where you can use the increased mobility to begin other treatments such as a physiotherapy programme.

Can I get a cortisone injection on the NHS?

Yes. Your GP, consultant or physiotherapist, can refer you for a corticosteroid injection if they feel it is best for your particular case. The injection might be administered at your GP, or at a specialist clinic or hospital department.

It is also possible to pay for private cortisone injection treatment to get seen faster. There are many clinics – including physiotherapy clinics and private doctors – who are able to offer corticosteroid treatment, including an assessment of your suitability and a private prescription.

How much does a cortisone injection cost?

The price of private steroid injections varies from clinic to clinic, starting at around £250 for one treatment. Most private clinics will offer some form of free assessment to determine whether injections are right for you, ensuring your condition can be treated effectively and that you have no contraindications to treatment.

Are cortisone injections a permanent solution?

Essentially, corticosteroid injections do not treat any underlying cause to your musculoskeletal problem but will address the inflammation and pain.

Often, steroid injections will work for around 3 months which can be enough for simple acute conditions (even when causing severe pain) to improve naturally.

Short term relief can also be a crucial step towards a longer-term solution. As well as creating relief from symptoms to pursue other therapies such as physiotherapy, the reduction in pain can allow the body to relax, leading to improved sleep and a reduction in stress hormones. This allows the body’s natural healing mechanisms to work more effectively.

Are there alternatives to cortisone injections?

Yes. Cortisone injections are not normally the first course of action when dealing with mild-to-moderate musculoskeletal pain, and more conservative treatments will often be recommended in the first instance.

Reducing or stopping any activities which are causing the problem, improving your general health along with physiotherapy exercises, stretching or manual therapies is usually the first step to attempt to rehabilitate the joint or tissue without the use of drugs.

Corticosteroid injections will normally be considered where conservative treatments have failed to adequately address the problem, or in cases when pain is severe and / or a limitation to other treatments.

Other types of injections such as hyaluronic acid injections or Arthrosamid can also be recommended in certain cases.

What are the disadvantages and side effects of cortisone injections?

Although steroid injections are generally a safe treatment, there are risks involved as with any drug or medical procedure. Rarely there will be an allergic or hypersensitive reaction to corticosteroids, which in extreme cases can result in anaphylaxis.

Medical professionals administering steroid injections are trained in spotting and dealing with these reactions. There is also an extremely rare chance of infection following the injection.

Minor side effects are more common, affecting 1 out of 5 patients. These may include temporarily increased pain in the area of the injection, bruising or other skin complaints such as flushing or depigmentation, and disturbed menstrual patterns. There are also risks of further cartilage degeneration and tendon rupture in some cases.

In every case it is a question of weighing up the pros and cons of cortisone injections and considering any contraindications to steroid treatment. Your healthcare practitioner, whether in the NHS or at a private clinic, will examine you and discuss your problem and medical background in order to help you come to a decision as to whether injections are the best course of action for you.

Conclusion

Corticosteroid injections can often be a lifeline to patients in chronic musculoskeletal pain. However they are not suitable for every case and you should discuss the potential risks and benefits with a qualified healthcare professional before coming to a decision whether it is the right treatment for you.

You should also try to stay in good overall health to allow your body to recover naturally following the steroid injection, and use the break in your symptoms to follow any other treatment plans – such as physiotherapy or exercise – to encourage a permanent improvement in your symptoms.

About the author

Maxence Legout is lead clinician at Insight MSK, a London ultrasound-guided cortisone injection clinic. He is a specialist physiotherapist and senior NHS clinician who administers over 2000 ultrasound-guided steroid injections every year.