Corticosteroid injections (commonly called cortisone shots) deliver a powerful anti-inflammatory medication directly into a joint, tendon sheath, bursa, or other painful area. They are used to treat conditions such as arthritis, bursitis, tendinitis, and inflammatory joint disease. Understanding what to expect in the days after an injection helps patients use the treatment effectively.
What Happens After a Cortisone Injection
Many corticosteroid injections also contain a local anesthetic (such as lidocaine or bupivacaine) that provides immediate but temporary pain relief lasting 4 to 8 hours. As this wears off, the treated area may feel more painful than before the injection.
A cortisone flare is a temporary increase in pain and swelling at the injection site that occurs in 2 to 10 percent of patients, typically within 24 to 48 hours of the injection. It is caused by a brief inflammatory reaction to the steroid crystals and usually resolves within 3 to 5 days.
The anti-inflammatory effect of the corticosteroid itself typically begins 2 to 5 days after the injection as the steroid is slowly released into the surrounding tissue. Full benefit may not be felt until 1 to 2 weeks post-injection.
Some patients experience temporary flushing of the face and neck within hours of the injection. This is a known side effect of steroid medications entering the bloodstream in small amounts and typically resolves within a day.
Patients with diabetes may notice elevated blood sugar levels for 3 to 7 days following a corticosteroid injection. This is a systemic effect of the steroid and should be monitored if you manage diabetes with insulin or oral medications.
Managing Pain and Swelling in the First 48 Hours
Apply ice to the injection site for 15 to 20 minutes at a time, 3 to 4 times per day, for the first 24 to 48 hours. Place a thin cloth between the ice pack and skin to avoid frostbite.
Over-the-counter acetaminophen (up to 1,000 mg every 6 hours, maximum 3,000 to 4,000 mg per day) can help manage post-injection discomfort. Avoid NSAIDs such as ibuprofen or naproxen within the first 24 hours, as they may blunt the anti-inflammatory effect of the corticosteroid.
Keep the injected limb or joint elevated where possible during the first 24 hours to reduce swelling. Avoid hot showers, baths, or heating pads on the injection area for the first 24 hours.
Rest the injected area for 24 to 48 hours. Avoid any strenuous activity or exercise involving the treated joint on the day of and the day after the injection.
If the cortisone flare is severe and not relieved by ice and acetaminophen after 72 hours, contact your care provider. Prescription-strength anti-inflammatories or a brief course of oral steroids may occasionally be needed.
Activity and Return to Normal Function
Avoid repetitive or high-impact use of the injected area for at least 1 to 2 weeks after the injection. Overloading the joint too soon can reduce the duration of benefit and potentially worsen the underlying condition.
Most patients can return to light daily activities within 24 to 48 hours. More demanding physical activity such as sports, gym workouts, or heavy lifting should wait until the full anti-inflammatory effect is felt, typically 1 to 2 weeks.
If you are undergoing physical therapy, inform your therapist about the injection and its timing. Therapy is often most effective when begun after the steroid has had 5 to 7 days to reduce inflammation.
Do not receive another corticosteroid injection into the same site within 3 months. Multiple injections too close together can weaken tendons, cartilage, and surrounding tissue.
Signs That Require Medical Attention
Seek immediate care if you notice increasing redness, warmth, and swelling at the injection site after the first 48 hours, accompanied by fever above 38 degrees C (100.4 degrees F). These may indicate a joint or soft tissue infection, a rare but serious complication.
Severe or worsening pain that does not begin to improve within 5 to 7 days of the injection warrants a follow-up call to your provider. The injection may not have been placed in the optimal location, or an underlying condition may require reassessment.
Sudden weakness or numbness near the injection site is uncommon and should be evaluated promptly. Though rare, nerve irritation can occur after certain types of injections.
Tell your provider if you are taking blood thinners. These medications are not a strict contraindication to corticosteroid injections, but they do increase the risk of bleeding at the site and may require dose adjustment before the procedure.
The local anesthetic in the injection provides immediate temporary relief for 4 to 8 hours. The corticosteroid itself usually begins to take effect within 2 to 5 days and reaches full benefit within 1 to 2 weeks.
Can I take ibuprofen or acetaminophen after a cortisone shot?
Acetaminophen is preferred for the first 24 hours after the injection. Avoid NSAIDs like ibuprofen or naproxen in the first 24 hours, as they may interfere with the steroid's anti-inflammatory effect. After the first day, either can be used as needed for residual discomfort.
How many cortisone injections are safe per year?
Most guidelines recommend no more than 3 to 4 injections per site per year, with at least 3 months between injections at the same location. More frequent injections increase the risk of cartilage damage and tendon weakening.
Is it normal for pain to get worse for a day or two after the injection?
Yes. This is called a cortisone flare and affects up to 10 percent of patients. It is caused by a temporary inflammatory reaction to the steroid crystals and typically resolves within 3 to 5 days. Ice and acetaminophen usually manage it well.
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