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Cortisone shots and epidural steroid injections both deliver corticosteroid medication to help reduce inflammation and pain, but they are administered in different areas.
Cortisone shots deliver medication directly into a joint, tendon, or bursa to treat inflammation in that specific area. Epidural steroid injections deliver medication into the epidural space around the spinal cord to treat inflammation affecting a wider area like the lower back and legs.
Cortisone shots can provide faster relief, within days, while epidural injections may take 1-2 weeks. However, epidural injections tend to provide longer lasting pain relief. Cortisone shots may need to be repeated every few months, while epidurals can potentially provide pain relief for many months at a time.
Epidural steroid injections are more involved procedures requiring imaging guidance to deliver medication around the spinal cord, while cortisone shots are quick injections into target joints or soft tissues. Both carry some risks like infection, but epidurals have more serious risks like nerve damage or spinal headache.
In general, cortisone shots are used for local joint or tendon pain like in the knees, shoulders, hips or wrists. Epidural steroid injections are used for widespread spinal nerve pain in conditions like spinal stenosis, herniated discs, or sciatica.
What is a Cortisone Shot?
A cortisone shot, also known as a corticosteroid injection, is a relatively quick and minimally invasive procedure used to deliver a dose of corticosteroid medication directly into a specific area of inflammation in the body. This helps reduce pain and swelling caused by inflammation in joints, tendons or bursae.
Cortisone is a synthetic version of the cortisol hormone naturally made by the adrenal glands. It has powerful anti-inflammatory effects. The corticosteroid medication used in these injections mimics the effects of the cortisone hormone.
Common conditions treated with cortisone injections include:
- Arthritis in joints like the knees, wrists, elbows, hips, shoulders, hands or ankles
- Bursitis such as trochanteric bursitis in the hip or subacromial bursitis in the shoulder
- Tendinopathies like tennis elbow, golfer’s elbow or Achilles tendonitis
- Carpal tunnel syndrome
- Trigger finger
- Plantar fasciitis
The purpose of cortisone shots is to deliver concentrated anti-inflammatory medication precisely to an inflamed bursa, joint or tendon. This helps reduce local swelling, pain, redness and stiffness.
How Cortisone Injections Are Administered
Cortisone shots are a quick and relatively easy in-office procedure. The patient sits or lies down and the doctor will clean and sterilize the skin area where the injection will be given. A local anesthetic may be used to numb the skin.
Using anatomical landmarks or ultrasound imaging guidance, the doctor inserts a thin needle directly into the target joint, bursa or tendon. Once in position, the corticosteroid medication is injected. The needle is withdrawn and a bandage applied.
The whole appointment usually takes just 10-15 minutes. Patients can go home shortly after. Soreness at the injection site or muscle pain may occur over the next couple days as side effects.
Cortisone Shot Benefits
Cortisone shots start working within a few days to provide significant symptom relief. Benefits include:
- Decreased inflammation, swelling, redness and warmth in the joint or soft tissue
- Reduced muscle spasms and pain
- Increased mobility of the joint and range of motion
- Improved function
Relief from a single cortisone shot can last for months at a time, but the duration varies. Many patients get lasting pain relief for 3-4 months. Some may only get a few weeks of relief. The effects tend to wear off over time as the medication gets metabolized and excreted.
Risks and Side Effects
Potential side effects from cortisone injections include:
- Increased pain or tenderness at injection site for a couple days
- Bruising, bleeding or skin discoloration
- Nerve injury (rare)
- Lightheadedness or fainting
- Facial flushing for 1-2 days
- Temporary spike in blood sugar (for diabetics)
- Joint infection (rare)
Too many cortisone shots in the same area can weaken tendons or cartilage over time. Doctors generally limit shots to 3-4 times per year spaced out by several months between injections. Diabetics may experience short-term elevated blood sugar after injections.
What is an Epidural Steroid Injection?
An epidural steroid injection is a minimally invasive procedure that delivers corticosteroid medication into the epidural space surrounding the spinal cord. This helps reduce inflammation of spinal nerves which can cause lower back pain and radiating leg pain.
Epidural injections are most commonly performed to treat radicular pain in the low back, legs and buttocks caused by inflammation of the spinal nerves. Common conditions treated with epidural steroid injections include:
- Herniated discs or bulging discs
- Spinal stenosis
- Degenerative disc disease
- Radiculopathy
- Sciatica or sciatic nerve pain
- Failed back surgery syndrome
Epidural steroid injections help deliver concentrated anti-inflammatory medicine right to the source of inflammation around irritated spinal nerves, often providing substantial pain relief.
How Epidural Steroid Injections Are Performed
Epidural steroid injections are administered under imaging guidance, most often using fluoroscopy x-ray. The patient lies face down and the back is cleaned. Local anesthetic numbs the injection area.
Using x-ray guidance, the doctor inserts a needle into the epidural space around the spinal cord, vertebrae and nerve roots. Once positioned, the steroid medication is injected.
The procedure usually takes 15-30 minutes. Some soreness may be felt afterwards. Patients can usually resume normal activities within a couple days.
Epidural Injection Benefits
Benefits of epidural steroid injections include:
- Decreased back and leg pain
- Reduced inflammation around spinal nerves
- Increased mobility and range of motion
- Improved ability to participate in physical activity
Pain relief may take 1-2 weeks to fully set in. Some patients get complete pain relief for many months, even over a year. But the effects are temporary and injections may need to be repeated. The degree and duration of pain relief varies by individual.
Risks and Side Effects
Epidural steroid injection side effects may include:
- Increased back or leg pain for a few days
- Headaches
- Facial flushing
- Fever
- Nausea
- Itchiness
- Dizziness
- Muscle spasms
- Spinal headache from leakage of cerebrospinal fluid
Rare but serious risks include spinal cord injury, nerve damage, paralysis, or infection. Steroids may temporarily elevate blood glucose especially in diabetics.
Cortisone Shots vs Epidural Steroid Injections: Key Differences
While cortisone shots and epidural steroid injections both deliver anti-inflammatory corticosteroid medication, there are some key differences:
Indications
- Cortisone shots are used to treat local inflammation in specific joints, bursae or tendons causing pain. Most often used for osteoarthritis, bursitis, tendinitis.
- Epidural steroid injections are used to treat nerve inflammation over large areas of the spine due to conditions like spinal stenosis, herniated discs or radiculopathy affecting the back and legs.
Anatomy
- Cortisone shots deliver medication into a precise joint, bursa or tendon.
- Epidural steroid injections deliver medication into the epidural space surrounding the spinal cord and nerve roots.
Medication
- Cortisone shots typically use quick-acting soluble corticosteroids like triamcinolone (Aristospan) or methylprednisolone (Depo-Medrol).
- Epidural steroid injections use longer-acting particulate steroids like betamethasone (Celestone) or dexamethasone (Decadron).
Onset of Relief
- Cortisone shots can start relieving pain within 1-3 days.
- Epidural steroid injections may take 1-2 weeks to provide full pain relief.
Duration of Relief
- Cortisone shots may provide relief for several weeks or months, but the effects wear off over time. Repeat injections needed every few months.
- Epidural steroid injections can provide pain relief for many months or even over a year in some cases. Repeat injections may be needed less frequently than cortisone shots.
Procedure
- Cortisone shots take just 10-15 minutes in the doctor’s office. Minimal imaging guidance needed.
- Epidural steroid injections take 15-30 minutes and must be done under fluoroscopy or other imaging guidance for proper needle placement due to the risk and complexity of injecting around the spinal cord.
Side Effects
- Cortisone shots potential side effects are localized and relatively mild, including pain at injection site, facial flushing, nerve injury.
- Epidural steroid injections can cause similar side effects but more widespread due to injecting into the spine. Risks like spinal headache, permanent nerve damage or paralysis are rare but serious.
The Bottom Line
Cortisone shots and epidural steroid injections both provide targeted anti-inflammatory pain relief, but there are important differences in their indications, injection locations, duration of relief, risks and procedures. Understanding when each is appropriate can help determine the best option for an individual’s specific condition and symptoms.
Cortisone shots offer a relatively quick and low-risk option focused on localized symptom relief for a few months at a time. Epidural injections involve a more extensive procedure but can provide longer lasting pain relief over widespread areas from spinal nerve inflammation.
Talk to a doctor about whether cortisone shots or epidural steroid injections are a more appropriate treatment option for your situation.
