Ultrasound diagnostics of the shoulder

Kortisone is a preparation that mimics the body's own hormone known ascortisol. Cortisol is one of the most important hormones in the body and is known as the "stress hormone" as it plays an important role in the body's stress response, but cortisone also affects the body's immune system and combustion. Cortisone can therefore be used effectively as an anti-inflammatory agent for persistent inflammation in tendons, joints and mucous membranes.Especially when we can use ultrasound to hit the tissue to be treated.

Area of ​​use and effect

Cortisone injection with ultrasound can be an effective treatment for inflammatory conditions in tendons, joints and mucous bags that do not go away. Cortisone is often relevant when relief and treatment options such aspressure wave, exercise, chiropractic, physiotherapyand other treatment that has not worked as it should. The injections are not inserted into the muscle itself, as this can lead to a poorer effect and risk of tendon damage. Whenthe injection is guided by ultrasound, so the chance of a positive outcome is considerably higher and we avoid affecting the healthy tissue. In some cases, cortisone is recommended in a very early stage such as frozen shoulder (frozen shoulder), DeQuervain's tendonitis, calcific bursitis, calcific bursitis and bursitis in the shoulder, elbow, hip, knee and ankle.

"..When onethe injection is guided by ultrasound, the chance of a positive outcome is considerably higher."

If you are unsure whether your condition should be considered for treatment with cortisone, you can contact us on 69 92 00 07 and speak to specialist Michael D. Parham, who will further confer with the medical officer and doctor Lars H. Fosse.

Typical injuries treated with cortisone

Avoid heavy activity on the body part you received the injection for the next two days. Overexertion of the treated joint can worsen the condition, but you can carry out normal daily activities. You will receive good information about relief and possible side effects after an injection. You will also be informed about when to start rehabilitation in the form of exercises to achieve the best possible result.

Why put cortisone with an ultrasound machine?

  • We want to hit the inflamed and painful tissue, while avoiding affecting the healthy tissue.

  • We use less cortisone per injection when we see what does.

  • We can control the needle so that you experience less discomfort than with "blind" injections.

  • You will need fewer treatments when we hit the inflamed tissue precisely.

Only for a selected patient group.

In the first instance, we will take a thorough medical history and survey your medical condition. We will then carry out an examination and ultrasound examination to determine whether injection is the right treatment option for you. We refer you to further examination by a medical specialist or other treatment measures if this is more appropriate.You should not receive cortisone if you have one of the following conditions:

  • Allergic to cortisone / triamcinolone acetonide.

  • Had one or more serious hypersensitivity reactions.

  • Vaccinated with live virus (recent).

  • Widespread/systemic infection.

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  • Thrombocytopenic purpura (disease that causes many small blood discharges in the skin).

  • Tuberculosis or gonococcal infection.

Side effects and risk

  • A small dose of cortisone that is inserted with ultrasound has few side effects.

  • The most common side effectis pain throughout the day where the injection is inserted. This type of pain will go away after a few hours or until the next day.

  • Rare side effectis change in the skin/loss of fatty tissue where the injection is placed. This side effect is reduced when the syringe is inserted correctly with ultrasound guidance. Less common serious side effects include dizziness, transient facial flushing, thinning of the skin/subcutaneous tissue, severe allergic reaction, menstrual disturbances and vaginal bleeding in postmenopausal women. Contact a doctor if you experience side effects, including possible side effects that are not mentioned in this text. You can also report side effects directly toThe Norwegian Medicines Agency: www.legemiddelverket.no/pasientmelding. DiabetesBlood sugar can be elevated after an injection with cortisone. We therefore want you to pay extra attention to this yourself.InfectionIn 1 in 1,000 cases, infection may occur. Sudden increase in pain along with fever, swelling and redness at the injection site may indicate this. See a doctor/emergency room if this should happen.

There must be a clear clinical basis before you are treated with cortisone

If we find a clear clinical basis for starting cortisone treatment, we will set up an appointment for you. You will receive an overview of important information and how to organize your everyday life to optimize the effect of the injection. A rehabilitation program will also be drawn up with training exercises that you must follow up when the pain subsides.

How much does the treatment cost?

Consultation hour/diagnosis with ultrasound, procedure and injection: NOK 1,299 Medical equipment, bottling, medicine/saline, conference with medical officer: NOK 350 Total treatment will cost: NOK 1,649 At the end of a course of treatment, we will send an epicrisis/report to GP, free of charge. 2-4 weeks are expected between treatments. This varies based on the size of the joint, level of inflammation and pain intensity. The number of injections depends on the body's own healing response and your activity level.

How do I make an appointment for cortisone treatment?

You can call 69 92 00 07 or make an appointment with Michael D. Parham who works with doctor Lars H. Fosse via our online booking.

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Medically responsible:Lars H. FosseClinical and sonographic responsible:Michael D. Parham

Frequently Asked Questions:

What is Cortisone?

Cortisone is similarcortisolwhich is a natural hormone in the body. Cortisol is often called the 'stress hormone' because of the role it plays in the body's stress response. Cortisol affects the absorption and consumption of the tissuesglucose, andthe immune system, which is utilized in treatment. Cortisone has around 80 percent of the effect you get from a similar dose of cortisol. As mentioned, the preparation is a natural hormone that you already have in your body, and the dose that is set is no greater than what you yourself produce on a day when you are very stressed.

Are there any precautions before a cortisone injection?

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In theCan I get cortisone when I'm sick?You must be fever-free for 14 days before treatment, a slight cold is ok (but not as long as the corona pandemic is raging). If you are sick, stay at home.Cortisone and antibiotics - do they go together?You must wait 14 days after the course has ended. For cortisone, we recommend 3-4 weeks, but it depends on how serious the infection is and what symptoms you have.Vaccine and cortisone - how long do I have to wait?We recommend 4 weeksDrug use and cortisone - what are the contraindications?We always ask for a list of your medications. Most can be adjusted according to the treatment, but do not need to be cut out.Can I take anti-inflammatories?Use of anti-inflammatory drugs (NSAIDS – ibux, brexidol, voltaren, naproxen) can be combined with injection treatment with cortisoneIf I have received injection treatment from the GP without effect, is there any point in coming to you?If the person in question put cortisone on you without ultrasound guidance, get in touch. We will take a picture and see if a further cortisone injection (or other type of follow-up / treatment) is necessaryHow many cortisone injections can one take per year?We recommend a maximum of 3 treatments per yearIs it a doctor who gives you the injection?Yes, we have a doctor who does the injection with us.Is cortisone injection treatment painful?No, it's usually not very painfulDo I need a sick leave and can I get this from you?This varies greatly from person to person, but yes, sometimes there may be an emergency with sick leave. If your job makes it difficult for you to take a break from activities we advise against, sick leave will be considered. We print sick notes at the clinic.Does an injection treatment work?Often you need 2 cortisone injections. You will return for a check-up appointment 10-14 days after the first injection. Based on the response to the treatment and the examination with ultrasound, it will be decided whether there is a need for 1 more treatment.Do I get the medical record or do you send information to the GP?You can take a printout of the medical record with you (costs NOK 100), otherwise we always send epicrisis to your GP or the person who referred you to us if we get your consent to share the information.What is the price of an ultrasound-guided injection with a cortisone injection?The price is NOK 1750 all inclusive. That is, for the initial examination with ultrasound, injection and for the preparation itself that is used.Do I need to come to a check-up appointment if the pain and symptoms are gone?The short answer is: Yes. The injection will almost always relieve the pain. Absence of pain does not mean that you are healthy, and it does not necessarily mean that the injury is gone for that reason. In order for you to get a good result from the treatment, it is crucial that a new assessment of the damage is made. A plan must also be drawn up for further treatment and in relation to a possible new injection. Training and adapted activity levels in the future are also something you need advice on.Are there side effects to cortisone treatment?Local redness around the injection area, light menstrual bleeding may occur. For safety's sake, we recommend that you stay for about 15 minutes after the injection so that we can see that there are no serious reactions to the treatment.


Does an ultrasound-guided cortisone injection hurt? ›

Ultrasound-guided injections are performed in the office. The injections involve a needle placed through your skin, which can be painful. However, we take care to numb the skin so that pain is minimal. No anesthesia is required.

What are the side effects of ultrasound-guided cortisone injection? ›

Using ultrasound to guide the needle reduces the chances of causing damage to surrounding structures. Side effects related to the procedure include bleeding, infection, numbness/weakness and allergic reaction to the medications used.

Can I drive after ultrasound-guided injection? ›

After your injection

Normal activities can be resumed the following day; however, you are advised not to do any strenuous exercise for a week. If it is a tendon injection you may be advised to avoid strenuous exercise for 2 weeks. You should not drive on the day of the treatment so please make alternative arrangements.

How much does ultrasound-guided injection cost? ›

On MDsave, the cost of a Joint Injection with Ultrasound Guidance ranges from $319 to $1043.

Where is the most painful place to get a cortisone shot? ›

Where is the most painful place to get a cortisone shot? The most painful place to get a steroid (cortisone) shot is into the palm, sole, or into any small space (such as an ankle joint). The size (length) and gauge (width) of the needle can also factor into the amount of pain you experience.

What is the recovery time for ultrasound guided steroid injections? ›

We advise you to rest for 24-48 hours after the procedure. You should benefit from the full effect of the steroids within 10 days. In rare cases, you may experience pain in the short term, following the image-guided injection.

Do you need to rest after a cortisone injection? ›

After a cortisone injection, it is strongly advised to rest the affected joint for 24 hours and refrain from doing strenuous activity or exercise for several days. Resting after the injection is vital to reduce inflammation effectively.

What is the downside of cortisone shots? ›

The Downsides

According to the National Institutes of Health, the side effects from cortisone shots include: Dizziness or headaches. Skin issues, including dryness, thinness, acne, dry skin, and red or purple blotches. Fatigue and trouble sleeping.

Why does it hurt so much after a cortisone injection? ›

The corticosteroids in the injection are formulated as slow-release crystals to give you long-term pain relief. Pain relief usually lasts for several months. However, the presence of these crystals can irritate your joint, which is what creates the sensation of pain around the area of the shot.

How long does it take for ultrasound guided injection to work? ›

How long does it take for a hip injection to work? Patients having this procedure should plan to rest and avoid activity for 24 hours. A return to strenuous activity should wait several days. On average, ultrasound-guided hip injections can take from 2 to 7 days before the pain noticeably subsides.

How long does a guided cortisone injection take to work? ›

It can take several days for the steroid to begin to work and may take up to 2-3 weeks for it to have maximum effect. The effect of the steroid can last for a week, several months or years. Sometimes, there is no pain relief from the injection. Avoid strenuous activity for at least 48 hours after the injection.

How successful are ultrasound guided injection? ›

With ultrasound guidance the accuracy of nearly every joint injection exceeds 90% and approaches 100% in many. Additionally, ultrasound guided injections have been shown to be less painful than blind injections.

What is the primary advantage of an ultrasound-guided procedure? ›

Utilizing ultrasound technology assures pinpoint accuracy of the needle into the appropriate tissue or joint space, enabling patients to obtain the maximum benefits of the medication injected.

Do you get a needle for an ultrasound? ›

During an Ultrasound-guided Biopsy, the Specialist Radiologist uses the ultrasound machine to locate and guide a specialised needle to the correct area of the body. The needle is then used to collect a tissue sample before being carefully removed from the body.

How long does a ultrasound injection last? ›

The steroid lasts for up to six weeks but the effects of the injection can sometimes last much longer. Your doctor will normally arrange a follow-up appointment with you after your injection. There are small risks associated with this injection, which you should be aware of before you proceed.

What is the difference between a steroid shot and a cortisone shot? ›

What Is the Difference Between Steroid and Cortisone Injections? Many people are curious about what differentiates a steroid injection from a cortisone shot. When discussing steroid and cortisone injections for orthopedic related conditions, the two terms are referring to the same injection product.

What is the next step if a cortisone shot doesn't work? ›

Generally, if the first shot doesn't work, we may inject the same area again after 6-8 weeks. However, if a second shot doesn't work, we don't recommend a third shot. But, you can have multiple cortisone shots in different parts of your body.

How many cortisone shots can you get in a lifetime? ›

There is no medical limit on the number of injections a person can receive. However, there are concerns about repeated cortisone injections in specific areas of the body. Also, individual response to a cortisone shot varies. Some patients do not experience pain relief with cortisone treatments.

Do guided steroid injections hurt? ›

There can be some minor discomfort at the time of injection, but most people tolerate the treatment very well, and often report that the procedure was far less painful than they had feared. Ultrasound guidance allows many injections to be performed in a way that much more comfortable for patients.

Should you walk after steroid injection? ›

After a steroid injection, you can return to most daily activities, including walking. The treating clinician may suggest against walking a distance/many steps. You should have no issues with walking out of the clinic upon completion of the injection.

Can I drive after ultrasound guided biopsy? ›

After Your Exam

You may eat and drink as normal after leaving the center. You should not drive the day of your procedure. The tissue sample will be sent to a laboratory for examination.

Is it hard to sleep after a cortisone shot? ›

Side effects of injections given into the blood tend to be similar to side effects of steroid tablets, such as increased appetite, mood changes and difficulty sleeping (insomnia).

Can you drive yourself after a cortisone shot? ›

Whilst there is not consensus and advice will vary between practitioners, It is generally recommended to wait at least 24 hours after a cortisone injection in the foot before driving or operating heavy machinery.

Does a cortisone shot go through your whole body? ›

With hydrocortisone injections, the medicine is placed directly into the painful or swollen joint. It does not travel through the rest of your body. That means, it's less likely to cause side effects. Sometimes, though, hydrocortisone from a joint injection can get into your blood.

Why do doctors not like to give cortisone shots? ›

There's concern that repeated cortisone shots might damage the cartilage within a joint. So doctors typically limit the number of cortisone shots into a joint. In general, you shouldn't get cortisone injections more often than every six weeks and usually not more than three or four times a year.

Does cortisone make you gain weight? ›

Weight and physical appearance

Description: corticosteroids are known to frequently cause weight gain in patients. This gain is is usually moderate, consisting of 1 to 2 kilograms of added mass.

Can a cortisone shot do more harm than good? ›

For example, recent studies show that repeated cortisone injections into joints can soften and increase cartilage damage. This damage may not be a concern for older patients where the damage has already been done. However, for younger patients, softening of cartilage is not so good.

Which is the most painful injection? ›

injections to give. Here is a simple technique that c.

How do you relieve pain from a cortisone shot? ›

Cortisone can deliver real relief from joint pain caused by inflammation, but some people will have a reaction from the shot. This is called a cortisone flare reaction. In most cases, the discomfort from a flare reaction is treated with rest, ice, and over-the-counter medication.

What pain relief can I take after a cortisone injection? ›

If it does occur and your discomfort increases, try to rest, apply ice to the area, and take over-the-counter pain medication, such as Motrin/Advil (Ibuprofen), Aspirin, or Tylenol, if needed.

How do I prepare for an ultrasound guided injection? ›

There is no specific way to prepare for an ultrasound-guided injection. Before the procedure, it will be explained to you and will have an opportunity to ask questions. After the injection, you may not feel any pain due to anesthetic.

How painful is an ultrasound guided hip injection? ›

The doctor will place the ultrasound probe over your hip to identify the hip joint. A numbing spray to minimize the sensation of the needle entering the skin will be applied to the skin, followed by a small caliber needle that will enter the joint. The patient may feel a sting for a few seconds.

Where is the best place to inject steroids for maximum results? ›

The best places to inject are your glutes, quads and delts. It's easier to inject into these bigger muscles but you still need to be careful to avoid blood vessels or nerves. Glutes – your glutes are the safest place to inject.

Are guided steroid injections painful? ›

There can be some minor discomfort at the time of injection, but most people tolerate the treatment very well, and often report that the procedure was far less painful than they had feared.

How painful is cortisol injection? ›

Cortisone injections are painful: The majority of patients expect the injection to be very painful, an most are pleasantly surprised that it isn't the case. At the time of injection it should hurt no more than a common immunization needle. Around 1:20 patients may have pain that is worse after the injection.

How long does a ultrasound guided injection take? ›

An ultrasound guided injection consultation and treatment typically lasts around 20-30mins.

Why was my cortisone shot so painful? ›

The corticosteroids in the injection are formulated as slow-release crystals to give you long-term pain relief. Pain relief usually lasts for several months. However, the presence of these crystals can irritate your joint, which is what creates the sensation of pain around the area of the shot.

Why does a cortisone shot hurt so bad after? ›

Some patients may experience a “cortisone flare” after their injection. This happens when the cortisone crystallizes and causes pain for a day or two. The pain may be worse than what you were living with before the shot. This is not a dangerous side effect, but it is uncomfortable.

How bad does a cortisone shot in the hip hurt? ›

Like any injection, a steroid injection can be a bit uncomfortable at the time. Any discomfort is only temporary. You also have a local anaesthetic to make the area that is treated numb. This means that you experience as little pain as possible.

Can you walk after a cortisone injection in the hip? ›

Can I walk after a cortisone injection in my hip? Yes, you can walk after the steroid injection in the hip, but it is beneficial to take the rest after the shot. It is safe to take painkillers such as ibuprofen and naproxen to reduce the pain.

Are you sedated for a hip cortisone injection? ›

Local anesthetic is used to numb the treatment area so discomfort is minimal throughout the procedure. The patient remains awake and aware during the procedure to provide feedback to the physician. A low dose sedative, such as Valium or Versed, is usually the only medication given for this procedure.

What is the downside to a cortisone shot? ›

The Downsides

According to the National Institutes of Health, the side effects from cortisone shots include: Dizziness or headaches. Skin issues, including dryness, thinness, acne, dry skin, and red or purple blotches. Fatigue and trouble sleeping.

Are you put to sleep for a hip injection? ›

The injection is carried out in theatre under a quick general anaesthetic or sedation so that you do not feel pain while the injection is being performed. Please do not eat anything after midnight the night before. You may have sips of water for up to two hours before your admission time, if required.


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