Cortisone Shot Side Effects: What to Know Before Your Injection

If your doctor has recommended a cortisone shot for arthritis, bursitis, or another source of joint pain, it’s worth understanding both the relief it can offer and the real trade-offs involved. Cortisone shot side effects range from a brief, expected flare of pain right after the injection to more significant risks that build up with repeated use over time. Here’s what the evidence actually shows, so you can have an informed conversation with your doctor about whether this treatment makes sense for your situation.

What Cortisone Shots Are Used For

Cortisone shots — also called corticosteroid injections — are used to reduce pain and inflammation from a range of joint and soft-tissue conditions, including osteoarthritis, rheumatoid arthritis, bursitis, and some cases of back pain or carpal tunnel syndrome. They’re commonly given in the shoulder, elbow, wrist, hip, knee, and ankle, targeting the specific joint or area causing symptoms. For many patients, a cortisone shot offers a way to reduce pain enough to participate more comfortably in physical therapy or daily activities, without resorting to surgery or relying solely on oral medications.

How Cortisone Shots Work

During the injection, a corticosteroid medication is deposited directly into or around the affected joint, where it works to reduce local inflammation. Because the steroid itself doesn’t provide immediate pain relief, a fast-acting local anesthetic is usually included in the same injection, offering relief within minutes while the corticosteroid’s anti-inflammatory effect builds over the following days. Full benefit typically develops within a few days of the injection, and relief can last anywhere from several weeks to a few months, depending on the condition being treated and how the individual responds.

Short-Term Side Effects

In the days immediately following a cortisone shot, a few effects are common and generally expected rather than cause for alarm:

• The “cortisone flare.” Some people experience a temporary worsening of pain in the treated area for about 1 to 2 days after the injection, before the anti-inflammatory effect takes hold and pain begins to improve.
• Temporarily elevated blood sugar. A small amount of the injected steroid can enter the bloodstream, which may raise blood sugar levels for a short period — a detail worth knowing if you have diabetes, since it’s worth monitoring glucose more closely for a few days afterward.
• A small risk of infection. Because the injection involves passing a needle through the skin, there’s a modest risk of introducing infection into the joint, though this is uncommon when the procedure is performed under sterile conditions.

Most people tolerate the procedure well, and these short-term effects typically resolve within a few days without any specific treatment beyond rest and, if needed, over-the-counter pain relief for the initial flare.

Risks From Repeated Injections

While an occasional cortisone shot is generally considered safe, repeated injections into the same joint over months or years carry accumulating risks that are worth understanding before committing to a long-term injection schedule:

• Cartilage damage. Corticosteroids can affect the cells responsible for maintaining healthy joint cartilage, and with repeated exposure, this may actually speed up the progression of arthritis in the treated joint rather than simply managing its symptoms.
• Tendon weakening or rupture. Additional injections raise the risk of tendon damage, which is part of why cortisone shots are generally avoided for tendinitis, particularly around the biceps, patellar (kneecap), and Achilles tendons, where rupture can be a serious complication.
• Diminishing returns. Because cortisone treats inflammation and pain rather than curing the underlying condition, many people notice that each subsequent injection provides somewhat less relief, or relief that doesn’t last as long, than the one before.
• Higher infection risk with frequency. Each additional injection represents another opportunity, however small, for infection to be introduced into the joint.

Why Doctors Generally Limit Injections to 3–4 Times a Year

There’s no strict, universally mandated legal limit on how many cortisone shots a person can receive, but most doctors follow a practical guideline of limiting injections into the same joint to roughly 3 to 4 times per year. This isn’t an arbitrary number — it reflects an attempt to balance the real pain relief cortisone can offer against the cumulative cartilage and tendon risks that build up with more frequent use. If a patient needs injections more often than this to manage symptoms, it’s usually a sign that the underlying condition needs a different or more comprehensive treatment approach, which might include physical therapy, a different medication class, or in some cases, a discussion about surgical options.

When Cortisone Shots Aren’t Recommended

A few specific situations call for caution or avoiding cortisone injections altogether:

• Tendinitis. Because of the tendon rupture risk, cortisone shots are generally not the preferred treatment for inflamed tendons, especially in weight-bearing or high-stress tendons like the Achilles.
• Shortly before joint replacement surgery. Doctors typically recommend waiting at least three months after a cortisone injection before joint replacement surgery, to reduce the risk of surgical site infection.
• Before joint restoration procedures. Procedures like microfracture surgery, which aim to stimulate new cartilage growth, may be less successful if performed too soon after a cortisone shot, so doctors may limit or avoid injections in patients being considered for these procedures.
• Active infection. Injecting a steroid into or near an already-infected joint can worsen the infection, so doctors will rule this out before proceeding.

Worth noting: cartilage damage from prior cortisone shots doesn’t affect the outcome of a joint replacement, since the entire joint surface is replaced during that surgery — the timing concern is specifically about infection risk, not cartilage health, at that point.

Cortisone Shots and Blood Sugar

For people with diabetes, it’s worth knowing that cortisone injections can cause a temporary rise in blood sugar, sometimes lasting several days. This happens because a small amount of the steroid can enter general circulation rather than staying confined to the joint. Monitoring blood sugar more closely than usual for about a week after an injection, and discussing the timing of the shot with both your diabetes care provider and the doctor administering the injection, can help you manage this effect proactively. Some longer-acting steroid formulations are associated with a smaller blood sugar impact, though they don’t necessarily provide better pain relief, so this is a trade-off worth discussing case by case.

What to Do After Your Injection

A few simple steps in the days following a cortisone shot can support a smoother recovery:

• Rest the treated joint for 24 to 48 hours, avoiding strenuous activity or heavy use
• Apply ice to the injection site if swelling or the flare reaction is bothersome
• Use over-the-counter pain relief, as recommended by your doctor, if the initial flare is uncomfortable
• Watch the injection site for signs of infection — increasing redness, warmth, swelling, or fever — over the following days
• Gradually return to normal activity as pain allows, rather than resuming high-impact activity immediately

Cortisone Shots Compared to Other Joint-Pain Treatments

A cortisone shot is rarely the only option on the table, and understanding how it stacks up against alternatives can help put its risks and benefits in perspective. Oral anti-inflammatory medications, such as ibuprofen or naproxen, work throughout the body rather than targeting one joint, which means milder localized relief but also a different set of risks, including stomach irritation and, with long-term use, kidney or cardiovascular concerns. Physical therapy addresses the underlying mechanics contributing to joint pain, such as weak supporting muscles or poor movement patterns, and doesn’t carry the cartilage or tendon risks of injections, though it typically takes longer to produce noticeable relief and requires ongoing effort.

Hyaluronic acid injections, sometimes called “gel shots,” are another option for some joints, particularly the knee, and work by supplementing the joint’s natural lubricating fluid rather than reducing inflammation directly; they tend to have a slower onset than cortisone but may last longer for some patients, with a different and generally milder side-effect profile. Platelet-rich plasma (PRP) injections, which use a concentrated portion of the patient’s own blood, are being studied as a treatment that may support tissue healing rather than simply masking inflammation, though the evidence for PRP’s effectiveness is still developing and it’s typically not covered by insurance. For more advanced joint damage, surgical options ranging from arthroscopic cleanup to full joint replacement become part of the conversation. None of these alternatives is a universal replacement for cortisone — each comes with its own trade-offs in cost, speed of relief, durability, and risk — which is why the right choice usually depends on the specific joint, the severity and cause of the pain, and what a patient has already tried.

When to Call Your Doctor

Most recoveries from a cortisone shot are uneventful, but certain symptoms warrant a call to your doctor rather than waiting it out:

• Increasing redness, warmth, or swelling at the injection site, especially if it worsens after the first day or two rather than improving
• Fever or chills following the injection
• Pain that is severe, worsening significantly, or lasting well beyond the typical 1- to 2-day flare window
• Any sudden weakness, popping sensation, or inability to use the joint normally, which could signal a tendon issue
• Blood sugar readings that remain significantly elevated for several days if you have diabetes

Frequently Asked Questions

How long does a cortisone shot take to work?

The local anesthetic included in most cortisone injections provides relief within minutes, but this wears off within a few hours. The corticosteroid’s actual anti-inflammatory effect typically takes a few days to build up, with many people noticing meaningful improvement within 3 to 7 days after the injection.

How long does pain relief from a cortisone shot last?

This varies considerably depending on the joint, the underlying condition, and individual response, but relief commonly lasts anywhere from several weeks to a few months. Because cortisone addresses inflammation rather than curing the underlying problem, pain often gradually returns as the medication’s effect wears off, which is part of why repeated injections aren’t a long-term standalone solution for most chronic joint conditions.

Can I exercise normally after a cortisone shot?

Doctors generally recommend resting the treated joint for 24 to 48 hours after the injection, avoiding strenuous or high-impact activity during that window. After this initial rest period, most people can gradually return to normal activity as comfort allows, though it’s worth following your doctor’s specific guidance, since recommendations can vary by joint and condition.

Is a cortisone shot the same as a steroid used for bodybuilding?

No, this is a common point of confusion. Cortisone and other corticosteroids used medically for inflammation are chemically and functionally different from anabolic steroids, which are sometimes misused to build muscle mass. Corticosteroid injections don’t build muscle and aren’t associated with the same risks linked to anabolic steroid misuse.

What happens if cortisone shots stop working for my joint pain?

If injections are becoming less effective or you’re needing them more frequently than the typical 3-to-4-times-a-year guideline, it’s a signal worth discussing with your doctor. This often means the underlying condition has progressed or needs a different treatment approach, which might include physical therapy, a different medication, a brace or supportive device, or in some cases, a conversation about surgical options like joint replacement.

This article is for general educational purposes and isn’t a substitute for personalized medical advice. Always talk with your doctor about whether a cortisone shot is appropriate for your specific condition and medical history.

Cortisone shots remain a genuinely useful tool for managing joint pain and inflammation for many people, offering real relief that can make physical therapy, daily activities, and simply getting through the day more comfortable. The trade-off is that this relief isn’t free of risk, especially with repeated use, which is exactly why doctors set practical limits on injection frequency and why understanding both the short-term flare and the longer-term cartilage and tendon risks helps you make an informed decision alongside your doctor rather than simply requesting “another shot” whenever pain returns.