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Cortisone and Corticosteroid Injections

What cortisone injections do, when they help, how long the effect lasts, and the risks of repeated injections for shoulder, elbow, wrist and hand conditions.

Overview

Intra-articular corticosteroid injections serve as a therapeutic option across various musculoskeletal conditions, though long-term efficacy varies by joint and procedure. For patients undergoing hip arthroscopy for femoroacetabular impingement syndrome, response to intra-articular corticosteroid injection was not associated with differences in 10-year patient-reported outcomes, achievement of clinically significant outcomes, or reoperation rates [1]. In contrast, for ankle osteoarthritis, the combination of corticosteroid and hyaluronic acid injection is more effective than corticosteroid alone in relieving pain [2].

Preoperative use of corticosteroids does not appear to increase infectious risk in certain soft-tissue procedures. Preoperative corticosteroid injection at all studied timepoints was not associated with an increased risk of postoperative deep infection after carpal tunnel release [3]. Furthermore, repeated corticosteroid injections were found to be safe in the treatment of carpal tunnel syndrome and did not affect the morbidity of subsequent release [9]. Timing of a single preoperative corticosteroid injection within 1 year of rotator cuff repair did not significantly affect failure rates, patient-reported outcomes, range of motion, or strength [7].

For hand and thumb pathologies, injection strategies and indications are specific. High-dose triamcinolone injections outperformed low-dose injections across most metrics including estimated time of relief, rate of repeat injection, and rate of surgery for soft tissue pathology of the hand [6]. There is a statistically significant difference in pain during and shortly after injection when using a steroid with lidocaine versus steroid alone for trigger finger, but that difference may not be clinically relevant [4]. Intraoperative corticosteroid pillar injection is not an effective option for preventing pillar pain symptoms after carpal tunnel release surgery [5]. Both surgical procedures are indicated for painful thumb carpometacarpal osteoarthritis after steroid injections [8].

How It Works

Efficacy and Outcomes: Response to intra-articular corticosteroid injection is not associated with differences in 10-year patient-reported outcomes, achievement of clinically significant outcomes, or reoperation rates in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome [1]. In ankle osteoarthritis, the combination of corticosteroid and hyaluronic acid injection is more effective than corticosteroid alone in relieving pain [2]. For soft tissue pathology of the hand, high-dose triamcinolone injections outperformed low-dose injections across most metrics including estimated time of relief, rate of repeat injection, and rate of surgery [6].

Procedural Timing and Safety: Preoperative corticosteroid injection at all studied timepoints is not associated with an increased risk of postoperative deep infection after carpal tunnel release [3]. Repeated corticosteroid injections are safe in the treatment of carpal tunnel syndrome and do not affect the morbidity of subsequent release [9]. Timing of a single preoperative corticosteroid injection within 1 year of rotator cuff repair did not significantly affect failure rates, patient-reported outcomes, range of motion, or strength [7]. However, a dose-dependent relationship exists between pre-operative corticosteroid injections and post-operative complications following total shoulder arthroplasty, with increasing numbers of injections correlated with higher risks of prosthetic loosening, stiffness, revision surgery, and new rotator cuff disease [20].

Intraoperative and Adjunct Considerations: Intraoperative corticosteroid pillar injection is not an effective option for preventing pillar pain symptoms after carpal tunnel release surgery [5]. There is a statistically significant difference in pain during and shortly after injection when using a steroid with lidocaine versus steroid alone, but that difference may not be clinically relevant [4]. Posterior approach, women, and history of preoperative corticosteroid injection were identified as the strongest risk factors for postoperative greater trochanter bursitis injection or postoperative soft tissue injection after total hip arthroplasty [19].

Specific Indications and Risks: Both surgical procedures are indicated for painful thumb carpometacarpal osteoarthritis after steroid injections [8]. Both corticosteroid injections and conservative treatments are effective in treating heel spurs, with corticosteroid injections recommended as the preferred option due to higher patient satisfaction [12]. Patients who experienced temporary improvement after local corticosteroid injection had better clinical outcomes following endoscopic plantar fascia release [15]. Risks of intra-articular hip corticosteroid injections include rapidly progressive osteoarthritis, osteonecrosis, femoral head collapse, insufficiency fracture, and worsening osteoarthritis [11].

What the Evidence Shows

Efficacy and Comparative Outcomes

Predictive Value for Surgical Outcomes: Response to preoperative intra-articular corticosteroid injection does not predict differences in 10-year patient-reported outcomes, achievement of clinically significant outcomes, or reoperation rates in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome [1]. Conversely, patients who experienced temporary improvement after local corticosteroid injection demonstrated better clinical outcomes following endoscopic plantar fascia release for chronic plantar fasciopathy [15].

Comparative Efficacy by Pathology: * Ankle Osteoarthritis: The combination of corticosteroid and hyaluronic acid injection is more effective than corticosteroid alone in relieving pain [2]. * Trigger Finger: There is a statistically significant difference in pain during and shortly after injection when using a steroid with lidocaine versus steroid alone, but that difference may not be clinically relevant [4]. * Hand Soft Tissue Pathology: High-dose triamcinolone injections outperformed low-dose injections across most metrics, including estimated time of relief, rate of repeat injection, and rate of surgery [6]. * Thumb Carpometacarpal Osteoarthritis: Both surgical procedures are indicated for painful thumb carpometacarpal osteoarthritis after steroid injections [8]. * Heel Spurs: Corticosteroid injections and conservative treatments were both effective, but corticosteroid injections are recommended as the preferred option due to higher patient satisfaction [12]. * Tendinopathy: Platelet-rich plasma (PRP) has superior midterm efficacy compared to corticosteroids for improving pain and functional impairment [21]. * Adhesive Capsulitis: Suprascapular nerve blocks provide greater pain relief at 3-4, 6-7, and 12 weeks, greater improvements in shoulder function at 12 weeks, and greater active abduction at 12 weeks compared to intra-articular corticosteroid injections [22].

Safety and Complications

Infection and Failure Rates: Preoperative corticosteroid injection at all studied timepoints was not associated with an increased risk of postoperative deep infection after carpal tunnel release [3]. Timing of a single preoperative corticosteroid injection within 1 year of rotator cuff repair did not significantly affect failure rates, patient-reported outcomes, range of motion, or strength [7].

Procedural Efficacy and Morbidity: Intraoperative corticosteroid pillar injection is not an effective option for preventing pillar pain symptoms after carpal tunnel release surgery [5]. Repeated corticosteroid injections for carpal tunnel syndrome were found to be safe and did not affect the morbidity of subsequent release [9].

Specific Risks and Alternatives: Risks of intra-articular hip corticosteroid injections include rapidly progressive osteoarthritis, osteonecrosis, femoral head collapse, insufficiency fracture, and worsening osteoarthritis, although the incidence rates of these outcomes vary notably [11]. Postoperative corticosteroid injection is a viable treatment for postoperative stiffness after rotator cuff repair and may serve as a safer alternative to arthroscopic capsular release, particularly in high-risk patients such as those with osteoporosis or at risk of axillary nerve injury [17].

Disparities and Methodological Concerns

Demographic Disparities: Minority demographics have lower odds of receiving corticosteroid injections for the treatment of hand osteoarthritis [13]. Minority demographics were less likely to receive a corticosteroid injection or undergo surgical repair for rotator cuff disease despite matching on medical comorbidities and smoking status [14].

Methodological Limitations: Methodological concerns regarding a trial comparing platelet-rich plasma to corticosteroid injections include the lack of ultrasound examination to assess inflammation and degeneration, the absence of Kellgren-Lawrence grade distribution data, and the potential confounding effect of lidocaine in corticosteroid preparations [10].

Practical Considerations

Preoperative Timing and Safety: Preoperative corticosteroid injection does not increase the risk of postoperative deep infection after carpal tunnel release [3]. In hip arthroscopy for femoroacetabular impingement syndrome, response to preoperative intra-articular injection is not associated with differences in 10-year patient-reported outcomes, achievement of clinically significant outcomes, or reoperation rates [1]. For rotator cuff repair, the timing of a single preoperative injection within 1 year does not significantly affect failure rates, patient-reported outcomes, range of motion, or strength [7].

Intraoperative and Postoperative Applications: Intraoperative corticosteroid pillar injection is not an effective option for preventing pillar pain symptoms after carpal tunnel release [5]. Postoperative corticosteroid injection is a viable treatment for postoperative stiffness after rotator cuff repair and may serve as a safer alternative to arthroscopic capsular release, particularly in high-risk patients such as those with osteoporosis or at risk of axillary nerve injury [17].

Comparative Efficacy and Modality Selection: Dual intra-articular injections of corticosteroid and hyaluronic acid are more effective than single corticosteroid injection for relieving pain in ankle osteoarthritis [2]. High-dose triamcinolone injections outperform low-dose injections across most metrics, including estimated time of relief, rate of repeat injection, and rate of surgery, for soft tissue pathology of the hand [6]. Platelet-rich plasma injections are inferior to corticosteroid injections for short-term pain relief, suggesting that expectations regarding the clinical utility of PRP should be tempered [18]. For trigger finger, there is a statistically significant difference in pain during and shortly after injection when using a steroid with lidocaine versus steroid alone, but that difference may not be clinically relevant [4].

Indications and Demographics: Both surgical procedures are indicated for painful thumb carpometacarpal osteoarthritis after steroid injections [8]. Both corticosteroid injections and conservative treatments are effective in treating heel spurs, but corticosteroid injections are recommended as the preferred option due to higher patient satisfaction [12]. Repeated corticosteroid injections are safe in the treatment of carpal tunnel syndrome and do not affect the morbidity of subsequent release [9]. Minority demographics have lower odds of receiving corticosteroid injections for the treatment of hand osteoarthritis [13] and are less likely to receive a corticosteroid injection or undergo surgical repair for rotator cuff disease despite matching on medical comorbidities and smoking status [14].

Risks and Research Gaps: Risks of intra-articular hip corticosteroid injections include rapidly progressive osteoarthritis, osteonecrosis, femoral head collapse, insufficiency fracture, and worsening osteoarthritis, although the incidence rates of these outcomes vary notably [11]. Methodological concerns regarding a trial comparing platelet-rich plasma to corticosteroid injections include the lack of ultrasound examination to assess inflammation and degeneration, the absence of Kellgren-Lawrence grade distribution data, and the potential confounding effect of lidocaine in corticosteroid preparations [10]. Further research, particularly with imaging adjuncts and detailed radiographic and inflammatory characteristics, is essential in optimizing intraarticular injectable therapies in knee osteoarthritis [16].

Key Evidence

  • [L2] Response to intra-articular corticosteroid injection was not associated with differences in 10-year patient-reported outcomes, achievement of clinically significant outcomes, or reoperation rates. (10.1016/j.arthro.2025.07.013)
  • [L1] The combination of corticosteroid and HA injection is more effective than corticosteroid alone in relieving pain in ankle OA. (10.1186/s12891-025-08488-0)
  • [L3] Preoperative corticosteroid injection at all studied timepoints was not associated with an increased risk of postoperative deep infection, a divergence from existing literature. (10.5435/jaaos-d-25-00317)
  • [L2] There is a statistically significant difference in pain during and shortly after injection when using a steroid with lidocaine versus steroid alone, but that difference may not be clinically relevant. (10.1016/j.jhsa.2024.05.016)
  • [L1] Intraoperative corticosteroid pillar injection is not an effective option for preventing pillar pain symptoms. (10.1186/s12891-025-09393-2)
  • [L4] High-dose triamcinolone injections outperformed low-dose injections across most metrics including estimated time of relief, rate of repeat injection, and rate of surgery. (10.1016/j.jhsa.2025.09.014)
  • [L2] Timing of a single preoperative corticosteroid injection within 1 year of rotator cuff repair did not significantly affect failure rates, patient-reported outcomes, range of motion, or strength, suggesting that one injection before repair does not strongly influence outcomes. (10.1016/j.jseint.2026.101632)
  • [L4] Both procedures are indicated for painful thumb carpometacarpal osteoarthritis after steroid injections. (10.1016/j.jhsa.2026.01.024)
  • [L3] Repeated injections were found to be safe in the treatment of carpal tunnel syndrome and did not affect the morbidity of subsequent release. (10.1177/17531934251396629)
  • [L5] The letter highlights methodological concerns regarding the original trial, specifically the lack of ultrasound examination to assess inflammation and degeneration, the absence of Kellgren-Lawrence grade distribution data, and the potential confounding effect of lidocaine in corticosteroid preparations. (10.1016/j.arth.2025.05.006)
  • [L5] Risks of intra-articular hip corticosteroid injections include rapidly progressive osteoarthritis, osteonecrosis, femoral head collapse, insufficiency fracture, and worsening osteoarthritis, although the incidence rates of these outcomes vary notably. (10.1016/j.asmr.2025.101169)
  • [L3] Both corticosteroid injections and conservative treatments were effective in treating heel spurs; however, corticosteroid injections are recommended as the preferred option due to higher patient satisfaction. (10.1186/s12891-025-08648-2)
  • [L3] Minority demographics have lower odds of receiving corticosteroid injections for the treatment of hand osteoarthritis. (10.1016/j.jhsg.2025.100837)
  • [L3] Minority demographics were less likely to receive a corticosteroid injection or undergo surgical repair for rotator cuff disease despite matching on medical comorbidities and smoking status. (10.1016/j.jse.2026.01.015)
  • [L3] Patients who experienced temporary improvement after local corticosteroid injection had better clinical outcomes following endoscopic plantar fascia release. (10.1186/s12891-025-08816-4)
  • [L5] The authors agree that further research, particularly with imaging adjuncts and detailed radiographic and inflammatory characteristics, will be essential in optimizing intraarticular injectable therapies in knee osteoarthritis. (10.1016/j.arth.2025.05.005)
  • [L5] Current findings suggest that corticosteroid injections may serve as a safer alternative to arthroscopic capsular release, particularly in high-risk patients such as those with osteoporosis or at risk of axillary nerve injury. (10.1016/j.arthro.2025.04.021)
  • [L1] Based on these findings, expectations regarding the clinical utility of PRP should be tempered. (10.1016/j.arth.2025.03.013)
  • [L3] Posterior approach, women, and history of preoperative corticosteroid injection were identified as the strongest risk factors for postoperative greater trochanter bursitis injection or postoperative soft tissue injection. (10.1016/j.arth.2025.03.045)
  • [L2] A dose-dependent relationship exists between pre-operative corticosteroid injections and post-operative complications following total shoulder arthroplasty, with increasing numbers of injections correlated with higher risks of prosthetic loosening, stiffness, revision surgery, and new rotator cuff disease. (10.1016/j.jse.2026.01.024)
  • [L1] PRP can effectively improve pain and functional impairment in patients with tendinopathy, and its midterm efficacy is superior to that of corticosteroids. (10.1186/s12891-025-08566-3)
  • [L1] In patients with adhesive capsulitis, suprascapular nerve blocks provide greater pain relief at 3-4, 6-7, and 12 weeks, greater improvements in shoulder function at 12 weeks, and greater active abduction at 12 weeks, compared to intra-articular corticosteroid injections. (10.1016/j.jse.2025.05.037)

References

[1] No Difference in Responders and Nonresponders to Preoperative Intra-articular Corticosteroid Injection Undergoing Hip Arthroscopy for Femoroacetabular Impingement Syndrome at 10 Years: A Matched Analysis. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2025. DOI: 10.1016/j.arthro.2025.07.013

[2] Dual intra-articular injections of corticosteroid and hyaluronic acid versus single corticosteroid injection for ankle osteoarthritis: a randomized comparative trial. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08488-0

[3] Ipsilateral Preoperative Corticosteroid Injection and Timing Not Associated With Postoperative Deep Infection After Carpal Tunnel Release. Journal of the American Academy of Orthopaedic Surgeons. 2025. DOI: 10.5435/jaaos-d-25-00317

[4] Corticosteroid Injection With and Without Local Anesthetic for the Treatment of Trigger Finger: A Randomized Clinical Trial. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.05.016

[5] “Intraoperative pillar corticosteroid injection”: does it improve clinical outcomes after carpal tunnel release surgery? A double-blind, randomized controlled study. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-09393-2

[6] Efficacy of Low-Dose Versus High-Dose Corticosteroid Injections for Soft Tissue Pathology of the Hand. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2025.09.014

[7] Timing of corticosteroid injection within 1 year prior to rotator cuff repair was not associated with increased risk of repair failure. JSES International. 2026. DOI: 10.1016/j.jseint.2026.101632

[8] Do Preoperative Intra-Articular Steroid Injections Affect the Choice of Surgical Procedures for Thumb Carpometacarpal Osteoarthritis?. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2026.01.024

[9] The safety and cost of repeated corticosteroid injections for carpal tunnel syndrome. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251396629

[10] Letter Regarding "Platelet-Rich Plasma Injections Are Inferior to Corticosteroid Injections for Short-Term Pain Relief: A Prospective, Double-Blinded, Randomized Controlled Trial". The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.05.006

[11] Risks of Intra‐articular Hip Corticosteroid Injections Include Rapidly Progressive Osteoarthritis and Femoral Head Collapse in Patients With and Without Pre‐existing Osteoarthritis: A Systematic Review. Arthroscopy, Sports Medicine, and Rehabilitation. 2025. DOI: 10.1016/j.asmr.2025.101169

[12] Comparison of corticosteroid injections and conservative treatments for heel spurs. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08648-2

[13] Underutilization of Hand Corticosteroid Injections and Arthroplasty for Minority Demographics. Journal of Hand Surgery Global Online. 2025. DOI: 10.1016/j.jhsg.2025.100837

[14] Minority groups are less likely to undergo surgical fixation or receive a corticosteroid injection for rotator cuff disease: a large database study. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.01.015

[15] Does local steroid injection have a prognostic value for endoscopic plantar fascia release in chronic plantar fasciopathy?. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08816-4

[16] Response to Letter to the Editor Regarding: "Platelet-Rich Plasma Injections Are Inferior to Corticosteroid Injections for Short-Term Pain Relief: A Prospective, Double-Blinded, Randomized Controlled Trial. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.05.005

[17] Editorial Commentary: Postoperative Corticosteroid Injection Is a Viable Treatment for Postoperative Stiffness After Rotator Cuff Repair. Arthroscopy. 2025. DOI: 10.1016/j.arthro.2025.04.021

[18] Platelet-Rich Plasma Injections Are Inferior to Corticosteroid Injections for Short-Term Pain Relief: A Prospective, Double-Blinded, Randomized Controlled Trial. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.03.013

[19] Does Surgical Approach in Total Hip Arthroplasty Affect Postoperative Corticosteroid Injection Requirements?. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.03.045

[20] Pre-operative corticosteroid injections are associated with a dose-dependent risk for complications following anatomic and reverse total shoulderarthroplasty. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.01.024

[21] Platelet-rich plasma and corticosteroid injection for tendinopathy: a systematic review and meta-analysis. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08566-3

[22] Intra-articular corticosteroid injection vs. suprascapular nerve block for adhesive capsulitis: a systematic review and meta-analysis of level I randomized controlled trials. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.05.037

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c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

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