Do you need a referral for cortisone injection

What Is Cortisone

Cortisone is the name given to a particular powerful anti-inflammatory medication which is administered via an injection into the painful and inflamed site. 

Cortisone is generally administered under ultrasound guidance from a sonographer or radiographer. Using a picture guidance via Diagnostic Ultrasound helps give the best outcome, knowing the injection has gone into the exact spot that it is required. 

Initially, local anaesthetic is injected into the area to provide immediate pain relief, prior to the cortisone injection being administered. 

Once the cortisone has been administered, you will likely be told to rest the area for a few days and then seek further advice from your physiotherapist.

What Conditions Is It Used For

Cortisone injections can become part of treatment for inflammatory conditions such as:

• Bursitis (commonly shoulder, hip)
• Tendinitis (commonly shoulder, elbow, hip, ankle)
• Spinal Pain (commonly lower back and neck pain, and often if referring into the leg/arm)
• Gout (often in the 1st toe)
• Osteoarthritis (commonly in the 1st toe, knee, spine)
• Rheumatoid arthritis

An animated example of a Cortisone Injection into a Bursa in the Shoulder

Physiotherapy Or Cortisone?

We are a little biased in our opinion, but as physiotherapists, we recommend conservative treatment (such as hands on physiotherapy and exercise) prior to seeking a cortisone injection. 

Physiotherapy treatment can provide you with relief from the pain, while also providing you with strategies to overcome the injury in the longer term through exercise, education and muscle retraining. 

Depending on the way the pain has come about can depend on how successful the injection may be. 

A Cortisone injection at times only provides short term relief (mainly from the local anaesthetic injected prior to the actual medication), and if the underlying cause of the problem is not addressed, then rehabilitation will not be successful and the injury will continue to reoccur. 

There are times where despite opting for physiotherapy management first, a Cortisone injection may be recommended particularly if your condition is not improving after 6-12 weeks. In this instance, after the injection, you will have to resume physiotherapy in order to strengthen the muscles in the area of injury and pain. 

When Should I Consider A Cortisone Injection

There are 3 main reasons why your Doctor might prescribe you a cortisone injection:

1. Your pain is significant (very intense)
2. Your pain/injury is slow to improve despite treatment
3. You have had your pain/injury for a long time and prioritise immediate relief

There are some cases where a Cortisone is successful in the very early stages of an injury such as a direct fall, trauma or bump onto a particular area.

In this case, the Cortisone is used to rapidly reduce pain and inflammation and allow normal range of movement to be restored.

Who Can Refer Me For A Cortisone

If having a Cortisone injection is something you are considering as part of your rehabilitation, speak with you GP. Your GP will be able to refer you for an Ultrasound and a Cortisone injection. 

If you are currently undergoing physiotherapy treatment, get your physio to send a letter to the GP informing them of your management thus far and why a Cortisone is recommended. 

You can also get a referral from your physiotherapist; however, you will likely have higher out of pocket costs compared to being referred by your GP.

I’ve Had A Cortisone Before But It Hasn’t Helped, Why?

We often here this in the clinic and there can be a few causes for this such as;

• The injection was not administered into the exact spot (sometimes the slightest angle or depth change can make all the difference)
• The area which the injection was administered was not the cause of the problem (for example an injection into the shoulder joint may not have great results if the problem is coming from your neck)

The most likely cause of this complaint is that the true underlying cause of the injury has not been addressed. 

It is essential your injury is correctly assessed and treated (before and/or after your injection), otherwise the pain will continue to come back time and time again. An alter in your biomechanics, muscle weakness in the area or continuing to undertake activities which are aggravating your injury can delay healing and return to normal function.

What Are The Next Steps After My Injection?

After having your Cortisone injection, you will likely experience immediate relief due to the anaesthetic as mentioned previously. 

After 24-48 hours, the anaesthetic will wear off and you may begin to experience pain again. It is important to note that the full effect of a Cortisone injection can take anywhere between 2-4 weeks to take full effect. 

Once you have had the injection, it is recommended that you begin (or resume) physiotherapy treatment in order to address the underlying cause/s of the pain/injury to minimise the risk of it becoming a long term, reoccurring issue.

Unsure what is the right first step for you?

Come in and speak with one of our physiotherapists and they will be able to guide you with the right steps you need to recover!

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