Is arm pain a normal side effect after receiving a cortisone (corticosteroid) injection in the joint?

Pain After Cortisone Joint Injection: Normal Side Effect and Management

Yes, it is normal to experience pain in your arm after a cortisone injection in the joint, with approximately 50% of patients experiencing increased pain that typically resolves within 1-2 days after the injection. 1

Understanding Post-Injection Pain

Types of Post-Injection Pain:

• Immediate pain: Caused by the needle insertion and the volume of medication injected
• Post-injection flare: Temporary worsening of pain that occurs in about 50% of patients, typically lasting 1-2 days 1, 2
• Prolonged pain: Less common, may persist beyond 5 days in approximately 17% of patients 1

Why Pain Occurs:

1. Crystal-induced synovitis: The steroid crystals can temporarily irritate the joint before taking effect
2. Injection technique: The procedure itself can cause tissue trauma
3. Volume effect: The fluid injected stretches the joint capsule

Expected Timeline

According to research, the pain pattern after cortisone injection typically follows this course:

• Day 0-1: Potential increase in pain (occurs in about 50% of patients) 1
• Day 1-2: Pain begins to subside for most patients
• Day 2-5: 83% of patients who experienced increased pain will have resolution by day 5 1
• Beyond day 5: Most patients (71%) experience improvement in their original symptoms 1

Management of Post-Injection Pain

The EULAR recommendations suggest the following approach for managing post-injection discomfort 3:

1. Rest the joint: Avoid overuse of the injected joint for 24 hours following injection, but complete immobilization is discouraged 3
2. Cold application: Apply ice to reduce local inflammation
3. Simple analgesics: Acetaminophen may be used for temporary pain relief
4. Avoid NSAIDs: Consider avoiding NSAIDs for 24-48 hours as they might interfere with the therapeutic effect of the steroid

When to Be Concerned

Contact your healthcare provider if you experience:

• Severe pain that is significantly worse than your pre-injection pain and persists beyond 2-3 days
• Signs of infection: Increasing redness, warmth, swelling, fever
• Skin changes: Paleness or atrophy at the injection site
• Joint instability: New feelings of joint weakness or instability

Special Considerations

• Diabetic patients: Should monitor blood glucose levels for 1-3 days after injection as temporary hyperglycemia is common 3, 4
• Multiple injections: The risk of side effects increases with the number and frequency of injections 4
• Pre-surgical patients: Cortisone injections should be avoided within 3 months prior to joint replacement surgery 3

Long-Term Considerations

While most post-injection pain is temporary, be aware of potential long-term effects of repeated cortisone injections:

• Cartilage thinning with frequent injections
• Tendon weakening
• Bone density loss with multiple injections 4

Current guidelines recommend limiting the frequency of injections to the same joint, though specific limits vary by joint and condition 3.