A cortisone injection is the delivery of a medicine from the corticosteroid class into a joint cavity, into the sheath around a tendon, or into an inflamed bursa. This is a potent anti-inflammatory drug group that acts locally to calm the inflammation driving pain and swelling. The aim is relatively quick pain relief that opens a window in which the patient can perform physiotherapy exercises and regain movement. The option is raised in acute pain flares of osteoarthritis, in flares of inflammatory arthritis, in bursitis and tendon-sheath inflammation, and in frozen shoulder. Candidacy is decided by clinical examination, review of imaging and general health status rather than by reading an article, and the site is chosen carefully because injecting a joint differs in purpose and technique from injecting a tendon sheath. The limits must be understood before consent: **cortisone does not treat the underlying cause, does not grow cartilage and does not halt the progression of osteoarthritis**, it does not repair a mechanical tear in a tendon or meniscus, and its effect is temporary with a duration that varies between patients. It is not repeated without limit, because repeated injections into the same joint at short intervals may harm cartilage and surrounding tissue; the treating doctor decides the appropriate interval. It is not injected into a joint suspected of infection. Some expected effects should be known in advance: a temporary rise in blood glucose in people with diabetes — an important point in Jordan given how common diabetes is — a pain flare in the first twenty-four to forty-eight hours before improvement, and thinning or lightening of the skin at the injection site. For this reason certain sites, such as the Achilles tendon, are avoided because of the risk of weakening the tendon. Two beliefs deserve correction: cracking joints does not cause osteoarthritis, and complete rest is not the best treatment for pain — once the injection has settled the pain, exercise is what preserves the result.
Procedure steps
- 1
Examination and identifying the site and cause
Clinical examination establishes whether the pain arises inside the joint or from a surrounding tendon or bursa, and imaging and history are reviewed, because injecting the wrong site means an injection that either fails to help or carries avoidable risk.
- 2
Reviewing diabetes, medicines and consent
The doctor asks about diabetes, anticoagulants, immune suppression and allergies, explains the temporary benefit, the expected side effects and the limits on repetition, and outlines the physiotherapy plan that will be built on the window of pain relief.
- 3
Sterile preparation of the site
The limb is positioned to open the target space, the skin is disinfected and allowed to dry, the needle path is identified by palpation or with ultrasound guidance, and the skin may be numbed locally before the needle is introduced.
- 4
Aspiration when needed, then injection
If the joint is swollen the fluid may be aspirated first and sent for analysis when infection or a gout attack is suspected. The medicine is then injected locally, sometimes combined with a local anaesthetic at the doctor’s discretion.
- 5
Observation, glucose monitoring and rehabilitation
The patient is observed for a few minutes, anyone with diabetes is advised to monitor glucose readings after the session, an exercise programme to start as pain settles is provided, and a follow-up visit is arranged to judge whether another step is needed.
Before the procedure
Tell your doctor if you have diabetes, because a cortisone injection can raise blood glucose temporarily and you may need closer monitoring of your readings after the session. Also list all your medicines, especially blood thinners, antiplatelet drugs and any treatment that suppresses immunity, and never stop a medicine on your own. Postpone the appointment and inform the clinic if you have a fever or an infection anywhere in the body, or a wound or skin inflammation over the injection site. Tell the doctor how many injections the same joint has already received and, if you know them, their dates, because this changes the decision. Wear loose clothing that exposes the joint easily, eat and take your usual medicines as normal since fasting is not required, and bring your glucose meter and any previous reports.
After the procedure
Rest on the day of the injection and avoid strenuous effort, heavy lifting and contact sport for two days to a week depending on the site and your doctor’s instruction, then begin the strengthening and range-of-motion exercises you were given — the injection opens a window, but exercise is what preserves the result. Expect a flare of pain in the first twenty-four to forty-eight hours before improvement begins; relative rest and a cold pack for short periods usually ease it. If you have diabetes, monitor your glucose readings for several days and contact your doctor if they rise unusually. **Seek emergency care immediately if you develop fever or shivering, if swelling, redness and heat in the joint increase with severe pain that prevents movement, or if pus leaks from the needle site** — these are signs of a septic joint and must not be left until another day.
Expected duration
The injection itself usually takes 5 to 10 minutes, and the full visit runs about 20 to 40 minutes including examination, sterile preparation and brief observation.
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