Corticosteroid Injection: Short-term anti-inflammatory modulation (Level 1)

Q1. What is a corticosteroid injection for the elbow?

A corticosteroid injection (often called a "cortisone shot") is a local treatment that delivers a powerful anti-inflammatory medication directly to a painful or inflamed area in your elbow. The injection contains a synthetic version of cortisol, a hormone naturally produced by your body to reduce inflammation. It is commonly used to provide rapid, targeted relief for elbow joint pain and swelling.

Q2. How does a corticosteroid injection help with elbow pain?

Corticosteroids work by strongly suppressing the local immune response and chemical pathways that cause inflammation. By reducing the swelling, heat, and irritation around your elbow tendons, joint lining, or bursa, the injection calms the inflamed tissue. This reduction in inflammation leads directly to decreased pain and improved joint mobility.

Q3. What specific elbow conditions can be treated with this injection?

Corticosteroid injections are commonly used to treat several elbow conditions, including:

• Lateral epicondylitis (tennis elbow)
• Medial epicondylitis (golfer's elbow)
• Olecranon bursitis (inflammation of the fluid-filled sac at the tip of the elbow)
• Elbow osteoarthritis or rheumatoid arthritis
• Localized tendonitis or joint inflammation

Q4. Why is this considered a "Level 1" non-surgical treatment option?

"Level 1" refers to first-line, conservative (non-surgical) treatments. A corticosteroid injection is considered Level 1 because it is a minimally invasive, outpatient procedure used early in the treatment plan. It is typically recommended when initial rest, bracing, and over-the-counter anti-inflammatory medications fail to provide enough relief to allow you to perform daily activities or participate in physical therapy.

Q5. What should I expect during the actual injection procedure?

The procedure is quick and usually performed in the doctor's office. First, the skin over your elbow is cleaned with an antiseptic solution. The doctor may use an ultrasound machine to precisely locate the inflamed area. The needle is then gently inserted, and the medication (usually a mix of the steroid and a local numbing agent) is injected. A small bandage is placed over the site, and the entire process takes only a few minutes.

Q6. Is the injection painful, and is anesthesia used?

You will feel a pinch and some pressure as the needle enters, but the discomfort is typically brief and mild. To make the procedure more comfortable, the steroid is almost always mixed with a local anesthetic (like lidocaine) that numbs the area immediately. This numbing effect provides instant relief, though it will wear off after a few hours before the steroid begins working.

Q7. How quickly will I feel pain relief after the injection?

Because the injection includes a fast-acting local numbing medication, you may feel immediate relief that lasts for a few hours. However, as the numbing agent wears off, your elbow pain may return temporarily. The corticosteroid itself takes time to work. Most patients start to experience noticeable, long-term pain relief within 2 to 7 days after the injection.

Q8. How long does the pain-relieving effect of a corticosteroid injection last?

The duration of pain relief varies from patient to patient and depends on the specific condition being treated. For many patients, a corticosteroid injection provides significant pain relief and reduced inflammation for several weeks to several months (often 6 to 12 weeks). In some cases of acute inflammation, the relief can be permanent, while for chronic conditions, it serves as a temporary window to allow for rehabilitation.

Q9. What is a "steroid flare," and what should I do if I experience it?

A "steroid flare" is a temporary increase in pain and inflammation at the injection site that can occur within the first 24 to 48 hours. It happens when the steroid medication crystallizes inside the tissue before dissolving. If you experience a flare, you can manage it by resting the arm, applying ice packs to the area for 15-20 minutes at a time, and taking over-the-counter pain relievers if recommended by your doctor. The flare typically resolves on its own within a couple of days.

Q10. Are there any risks or side effects associated with corticosteroid injections?

While corticosteroid injections are generally very safe, potential side effects include:

• Temporary pain or swelling (steroid flare)
• Skin thinning or loss of color (depigmentation) at the injection site
• Loss of fatty tissue (fat atrophy) under the skin, leaving a slight dimple
• Temporary rise in blood sugar (especially important for patients with diabetes)
• A very small risk of local infection (less than 1 in 10,000 cases)

Q11. What activities should I avoid immediately after getting the injection?

You should rest your elbow and avoid heavy lifting, strenuous reaching, pulling, or repetitive arm movements for at least 48 hours after the injection. This resting period allows the medication to settle in the target tissue and reduces the risk of aggravating the tendons. You can resume light daily activities, but listen to your body and do not push through pain.

Q12. How many corticosteroid injections can I safely receive in my elbow?

As a general clinical guideline, we recommend limiting corticosteroid injections to no more than 3 to 4 times per year in the same elbow joint, and even fewer (often only 1 or 2) directly around tendons. Repeated injections in the same area can weaken local tissues and increase the risk of tendon damage or skin thinning.

Q13. Why do doctors limit the number of corticosteroid injections?

We limit the frequency because repeated exposure to high concentrations of corticosteroids can lead to structural weakening of the tendons and cartilage in the elbow. If an injection only provides brief relief or fails to work after a couple of tries, continuing to inject steroids will not cure the underlying problem and may cause tissue degeneration or tendon tearing.

Q14. Should I continue physical therapy or exercises after getting the injection?

Yes, absolutely. The primary goal of the injection is to reduce your pain so that you can comfortably and effectively participate in physical therapy and rehabilitation. Once the inflammation is controlled, performing targeted exercises to stretch, strengthen, and stabilize the elbow muscles is essential for long-term healing and preventing the injury from returning.

Q15. What are the next steps if the corticosteroid injection does not relieve my elbow pain?

If the injection does not provide sufficient relief, or if the pain returns quickly, Dr. Veillette and his team will re-evaluate your condition. We may recommend:

• Advanced imaging, such as an MRI or ultrasound, to check for tendon tears
• Targeted physical therapy programs
• Other non-surgical treatments, such as Platelet-Rich Plasma (PRP) injections or shockwave therapy
• Surgical consultation to discuss minimally invasive or open procedures if all conservative options have been exhausted

We encourage you to write down any specific questions you have and discuss them thoroughly with your surgeon, doctor, or physical therapist. They are your best resource for personalized advice and care.

Disclaimer: This brochure provides general information and is not a substitute for professional medical advice. Always consult your doctor or qualified healthcare provider with any questions you may have regarding your specific medical condition and treatment plan.