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Cortisone Injections NYC — Orthopedic Corticosteroid Injections at New York Bone & Joint

Symptoms & ConditionsCortisone Injections NYC — Orthopedic Corticosteroid Injections at New York Bone & Joint

Written by: Dr. Popovitz.

Board-Certified Orthopedic Surgeon | Fellowship-Trained Sports Medicine, NYU Langone Medical Center | FAAOShopedic Surgeon in New York

Co-Founder, NY Bone & Joint Specialists | Lenox Hill Hospital - Northwell Health

Recognized: New York Magazine Best Doctor | New York Times Super Doctor | IAOS Leading Physician of the World | IAOS Top Orthopedic Surgeon in New York

Date Published: May 1, 2026

Last Medically Reviewed: May 1, 2026

This page has been written and reviewed by a fellowship-trained, board-certified orthopedic surgeon with over 20 years of clinical experience. All clinical claims are supported by peer-reviewed literature and current AAOS and AOSSM guidelines. See References section below.

At a glance

  • What it is: A corticosteroid (cortisone) injection delivers a powerful anti-inflammatory medication directly into a joint, bursa, or soft tissue to reduce pain and swelling. It treats inflammation; it doesn’t repair structural damage.
  • Body regions treated: Shoulder (subacromial bursa, glenohumeral joint, AC joint), knee (joint, pes anserine bursa), hip (greater trochanteric bursa, hip joint), spine (facet joints, epidural space), foot and ankle (plantar fascia, Achilles, ankle joint).
  • Who performs it: New York Bone & Joint sports medicine physicians for most indications; orthopedic surgeons when the injection is part of a surgical evaluation or treatment plan. All performed at both Manhattan offices, meaning there’s no hospital visit required.
  • Where: Upper East Side (1198 Third Ave) and Midtown (425 Madison Ave), Manhattan. In-office procedure: no anesthesia, no recovery time.
  • What to expect: Most patients experience pain relief within 3–5 days. Duration of relief varies by condition and individual: weeks to several months. Injections are not permanent solutions and are limited in frequency to protect joint health.
  • Important limits: Generally no more than 2-3 injections per year in the same joint. Repeated cortisone in a weight-bearing joint carries documented cartilage risk. [4] [5] An injection that stops working is a signal that the underlying condition needs re-evaluation.
  • Insurance: Most major insurance accepted. Coverage for cortisone injections is typically straightforward for documented inflammatory conditions.

Introduction

Cortisone injections are one of the most commonly performed procedures in orthopedic medicine. When administered for the right condition, at the right time, with accurate placement, a cortisone injection can provide meaningful pain relief that allows a patient to complete physical therapy, return to activity, or avoid surgery altogether. When it is not the right answer, it relieves pain without addressing the cause, and in doing so can delay the correct diagnosis by weeks or months. [1]

At New York Bone & Joint Specialists, our sports medicine physicians and orthopedic surgeons administer cortisone injections as a precisely indicated component of a complete treatment plan, not as a first response to any joint pain. Every patient who comes to New York Bone & Joint Specialists for an injection first receives an evaluation that confirms the appropriate indication, reviews existing imaging, and establishes what the injection can realistically achieve. We use ultrasound guidance to maximize injection accuracy. And we set honest expectations about duration of relief, frequency limits, and what a diminishing response to repeated injections means for the underlying condition.

This page covers cortisone injections for all orthopedic conditions across all body regions from shoulder, knee, hip, and spine to foot and ankle with specific guidance on indications, what to expect, how often they can be repeated, and when cortisone is not the right answer.

How Cortisone Injections Work

Cortisone is a corticosteroid, a synthetic version of the anti-inflammatory hormone your body naturally produces. When injected directly into a joint, bursa, or soft tissue, it reduces the local inflammatory response: decreasing swelling, calming the immune reaction driving the inflammation, and in doing so, reducing pain. [1]

The critical distinction is what cortisone does and does not do. It treats inflammation. It doesn’t repair torn tendons, heal cartilage, fix structural instability, or resolve mechanical problems. When pain is caused primarily by inflammation (such as bursitis, synovitis, tendinitis, inflammatory arthritis), cortisone can be highly effective. When pain is caused by a structural problem (such as a torn rotator cuff, a displaced meniscus, a ruptured ACL, a nerve compressed by a herniated disc), cortisone addresses only the secondary inflammation, not the primary cause.

“This distinction is the most important thing I explain to patients before any injection. The question isn’t just ‘will this injection help?’ The question is ‘what’s causing your pain, and is cortisone the right treatment for that specific cause?’ A patient with rotator cuff impingement from a bone spur and secondary bursitis will often get significant relief from a subacromial injection. A patient with a full-thickness rotator cuff tear will get temporary relief from the same injection but the tear will still be there when it wears off, and it will likely be bigger. Those are completely different clinical situations that can look identical on the surface. In fact, a cortisone injection in someone with a tear that needs to be repaired, such as a rotator cuff tear, can hinder healing when the surgery is performed. They would therefore need to wait a few months before proceeding. A young patient with a tear that must be repaired to preserve the joint for many years to come, such as an ACL tear, should typically not receive a cortisone injection. Therefore, cortisone can be an excellent pain reliever but the doctor has to be certain the use is appropriate.” — Leon Popovitz, MD

Conditions Treated With Cortisone Injections at New York Bone & Joint

The following table covers the most common orthopedic indications for cortisone injections by body region, the specific injection target, and what the evidence supports in terms of expected outcomes.

Body Region Condition Injection Target What to Expect Notes
Shoulder Rotator cuff impingement & bursitis Subacromial bursa Good short-term relief (weeks to months). Allows physical therpay to proceed more effectively. [2] Most effective when impingement is primary; not a substitute for evaluating for structural rotator cuff tear. [10]
Shoulder Glenohumeral (shoulder joint) arthritis or synovitis Glenohumeral joint space Pain relief for inflammatory arthritis, post-traumatic synovitis. Duration varies by severity. Not appropriate as primary treatment for labral tears, instability, or SLAP pathology.
Shoulder Adhesive capsulitis (frozen shoulder) Glenohumeral joint ± subacromial bursa Reduces inflammation; can accelerate recovery when combined with physical therapy. Earlier injection may shorten course. Best used alongside a structured stretching and physical therapy protocol. This has actually shown to be very effective if physical therapy alone is not making enough progress.
Shoulder AC joint arthritis or osteolysis AC joint Targeted relief for isolated AC joint pain from arthritis or weight-lifter’s shoulder. More precise than subacromial injection for isolated AC joint symptoms.
Knee Knee osteoarthritis Intra-articular (knee joint) Consistent short-term pain relief. Duration typically 4–12 weeks. [3] Frequency limits apply. Repeated injections in OA knees associated with accelerated cartilage loss. [4] [5] Evaluate for concurrent structural pathology.
Knee Pes anserine bursitis Pes anserine bursa (medial knee) Typically good response. Often underdiagnosed cause of medial knee pain. Distinguish from medial compartment OA or medial meniscus pathology: clinical examination is critical.
Knee Patellar tendinitis / patellofemoral pain Peritendinous / retropatellar Limited evidence for direct tendon injection. Peritendinous injection may help. Direct patellar tendon injection not recommended. Physical therapy and load management are primary treatment.
Hip Greater trochanteric bursitis Greater trochanteric bursa Strong evidence for pain relief. First-line non-surgical treatment. [7] Distinguish from gluteus medius/minimus tear; ultrasound guidance important to confirm bursal vs. tendon pathology.
Hip Hip joint osteoarthritis Intra-articular hip joint (image-guided) Moderate evidence for short-term relief. Requires imaging guidance (ultrasound or fluoroscopy) for accurate placement. Hip joint injection significantly harder to place accurately without guidance. Always image-guided at New York Bone & Joint.
Spine Facet joint arthritis (cervical or lumbar) Cervical or lumbar facet joints Good relief when facet arthropathy is the primary pain generator. Duration variable. Requires imaging guidance. Often performed by pain management specialists in conjunction with New York Bone & Joint evaluation.
Spine Epidural (nerve root inflammation) Epidural space Indicated for radiculopathy from disc herniation with nerve root irritation. Reduces nerve inflammation. Epidural injections performed by New York Bone & Joint pain management specialists. Not a substitute for structural evaluation when indicated.
Foot & Ankle Plantar fasciitis Plantar fascial insertion Effective for refractory plantar fasciitis. Best after 6 weeks of failed conservative care. [9] Ultrasound guidance recommended. Repeated injection risks plantar fascia rupture.
Foot & Ankle Achilles tendinopathy Peritendinous (NOT into tendon) Peritendinous injection may reduce paratenon inflammation. Direct tendon injection contraindicated. Never inject directly into the Achilles tendon due to risk of tendon weakening and rupture. New York Bone & Joint uses ultrasound guidance to confirm needle position.
Foot & Ankle Ankle joint arthritis / synovitis Ankle joint space Useful for inflammatory arthritis and post-traumatic synovitis. Ultrasound guidance improves accuracy in the ankle.
General Inflammatory arthritis flare (rheumatoid, psoriatic, gout) Affected joint Cortisone is highly effective for acute inflammatory arthritis flares across any joint. Coordinate with rheumatology for systemic management. Injection addresses local joint inflammation.

Ultrasound-Guided Injections: The New York Bone & Joint Standard

Accuracy of needle placement is one of the most significant variables in injection outcomes. Studies show that ultrasound-guided injections achieve significantly better accuracy and clinical outcomes compared to landmark-guided (palpation-based) injections for most orthopedic targets. [8] At New York Bone & Joint, ultrasound guidance is the standard for injections where it improves accuracy, which includes hip joint injections, shoulder injections for deep or complex targets, greater trochanteric bursa injections, plantar fascia injections, and Achilles peritendinous injections.

What ultrasound guidance means in practice: your physician uses a real-time ultrasound image to visualize the target (such as the bursa, joint space, or soft tissue) and watch the needle advance to the exact location before injecting. There’s no guessing, no relying on surface landmarks, and no risk of inadvertent injection into adjacent structures. For structures like the hip joint, the Achilles tendon, and the plantar fascia where misdirection carries specific risks image guidance is not optional.

“Ultrasound also gives us diagnostic information at the time of injection. Before our doctors inject the subacromial space of a patient with shoulder pain, we scan the rotator cuff on ultrasound. If we see a significant full-thickness tear, then that changes the clinical picture. A tear may make an injection the wrong treatment or changes the injection target. The injection and the diagnostic ultrasound happen at the same visit. That’s a different level of care than a landmark injection based on where the patient reports pain.” — Leon Popovitz, MD

When Cortisone is the Wrong Treatment

This section is the most important thing on this page for a patient who has been offered a cortisone injection and is trying to decide whether it’s the right next step. Cortisone isn’t always the right answer. In some situations, it can actively delay the correct diagnosis or contribute to harm.

Conditions where cortisone isn’t the primary answer or carries specific risk:

  • Full-thickness rotator cuff tears: Cortisone relieves the secondary bursitis inflammation but doesn’t address the structural tear, which continues to progress. Repeated subacromial injections in patients with underlying full-thickness tears have been associated with impaired tendon healing and increased re-tear rates after surgery. [10] A cortisone injection for shoulder pain without first ruling out a significant rotator cuff tear is a missed diagnosis in progress.
  • SLAP tears and labral pathology: SLAP tears are inside the shoulder joint, not in the subacromial space. A subacromial cortisone injection doesn’t reach the labrum or biceps anchor. Patients with symptomatic SLAP tears who receive subacromial injections are receiving treatment for the wrong anatomical location. The diagnosis needs to be established first. Typically, we don’t recommend a cortisone injection in a young athletic patient with a SLAP tear, especially if considering a repair.
  • Meniscus root tears and structural meniscus pathology: Cortisone can temporarily reduce synovitis in a knee with a meniscus tear but does not address the underlying structural problem. For posterior root tears in particular, where every month of delay accelerates arthritic progression, a cortisone injection that provides temporary relief is dangerous. It can give both patient and physician a false sense that the condition is managed.
  • ACL-deficient knees: Cortisone treats joint inflammation. It doesn’t restore the mechanical stability that a torn ACL provides. In an ACL-deficient knee with synovitis, injection may provide temporary relief, but the instability and the meniscus and cartilage damage that instability causes over time continues. We typically don’t recommend a cortisone injection for a young patient with an ACL tear.
  • Repeated injections in weight-bearing joints: Multiple studies have documented accelerated cartilage loss and osteoarthritis progression with repeated intra-articular corticosteroid injections, particularly in the knee. [4] [5] More than two to three injections per year in the same knee joint isn’t a treatment strategy: it’s a risk profile. When the duration of relief from each injection shortens, that is a signal that the underlying condition needs re-evaluation, not a higher-frequency injection schedule.
  • Achilles tendon: Direct injection into the Achilles tendon body is contraindicated due to documented risk of tendon weakening and rupture. Peritendinous injection for paratenon inflammation is appropriate and safe. The distinction requires ultrasound guidance.

“The pattern I see most often is a patient who has received three or four cortisone injections over the past year or two, without any imaging more than an x-ray, with each one providing slightly less relief than the last. The diminishing response isn’t a coincidence. It’s the condition telling you that the inflammation is not the primary problem anymore, and that something structural is driving the pain. That’s the moment to stop injecting and start evaluating.” — Leon Popovitz, MD

From Dr. Popovitz: When an Injection is the Right Answer, and When it Isn’t

A 52-year-old avid golfer came to see me with bilateral knee pain. He had been receiving cortisone injections (two per year in each knee) at another practice for about two years. Each injection provided relief, but the duration had shortened from about three months after the first injection to about six weeks after the most recent one.

When I examined him and reviewed his imaging, the picture was more complex than bilateral osteoarthritis. The right knee had moderate medial compartment OA, and cortisone was a reasonable part of managing that. But the left knee had a posterior medial meniscus root tear that had been present on the MRI for at least a year and hadn’t been flagged. The root tear was what was causing the left knee pain. The cortisone was treating the resulting synovitis while the root tear caused arthritis to progress.

We repaired the meniscus root tear on the left. For the right knee, we administered a properly spaced cortisone injection, started a targeted physical therapy protocol, and set a clear plan: if the right knee continued to deteriorate and became symptomatic despite optimal conservative care, we would discuss what was next.

Now, he’s back to playing golf. The left knee feels significantly better than it has in two years. The right knee is managed, not ignored.

The lesson isn’t that cortisone is bad. The lesson is that cortisone is a tool with specific indications. When the indication is right, it works. When it’s being used as a substitute for a diagnosis, it delays the right answer. My job is to know which situation I’m in before I pick up any instrument.

— Leon Popovitz, MD

What to Expect: Before, During, and After

Before the Injection

Your New York Bone & Joint physician will review your symptoms, examine the affected area, and confirm that cortisone injection is the appropriate next step for your specific condition. If you haven’t had recent imaging and the clinical picture warrants it, we may recommend an X-ray or MRI before proceeding. You don’t need to do anything special to prepare. You can eat normally, take your regular medications, and drive yourself to and from the appointment.

During the Injection

The procedure takes approximately 10–15 minutes from start to finish. The skin is cleaned and a local anesthetic may be applied. Using ultrasound guidance where indicated, the needle is advanced to the target location and the corticosteroid is injected. Most patients describe the procedure as mildly uncomfortable rather than painful. You’re awake throughout. No sedation is required. [1]

After the Injection

You may experience a temporary increase in pain or soreness at the injection site for 24–48 hours. This is a normal post-injection reaction called a steroid flare, and it resolves on its own. Ice and over-the-counter pain medication can help. Most patients experience meaningful pain relief within 3–5 days. We recommend avoiding strenuous activity for 24–48 hours post-injection, after which you can resume normal activities as tolerated.

Risks and Considerations

Cortisone injections are generally safe when administered appropriately and with adequate spacing. Risks to understand before proceeding: [1]

  • Post-injection flare: Temporary worsening of pain for 24–48 hours after injection, caused by crystal-induced synovitis from the corticosteroid formulation. More common with certain formulations. Resolves without intervention.
  • Skin and soft tissue changes: Repeated injections near the skin surface can cause localized depigmentation (skin lightening) or subcutaneous fat atrophy. More common with superficial injections and higher-concentration formulations. Minimized by appropriate injection depth.
  • Blood sugar elevation: Cortisone can temporarily raise blood glucose, particularly in diabetic patients. If you have diabetes, monitor your blood sugar for 24–48 hours post-injection and inform your physician. If your diabetes is poorly controlled then it’s best not to do the injection and consult with your primary care doctor for better control before proceeding with the cortisone injection. 
  • Cartilage risk with repeated injections: Multiple studies have documented accelerated cartilage loss and osteoarthritis progression with frequent intra-articular corticosteroid injections in weight-bearing joints. [4] [5] This is why New York Bone & Joint limits injection frequency and re-evaluates patients whose relief duration is shortening.
  • Tendon weakening: Repeated peritendinous injection near major tendons can weaken tendon tissue. Direct injection into the Achilles tendon body is contraindicated. Ultrasound guidance at New York Bone & Joint confirms needle position and prevents inadvertent tendon injection.
  • Infection: Rare. Less than 1 in 10,000 injections in experienced hands with proper sterile technique. [1]

Why Choose New York Bone & Joint for Cortisone Injections?

New York Bone & Joint Advantage What It Means for You
Diagnosis first, injection second Every patient receives a clinical evaluation before injection. We don’t administer cortisone as a reflex response to joint pain. The diagnosis determines whether injection is appropriate, and if so, exactly where.
Ultrasound guidance as standard We use ultrasound guidance for injections where it improves accuracy: hip joint, shoulder, greater trochanteric bursa, plantar fascia, Achilles peritendinous. Not all practices do this. Accuracy matters. [8]
Honest expectations We tell you how long relief is likely to last, how many injections are appropriate, and what a diminishing response means. We don’t schedule the next injection when the current one wears off.
Integrated care team If your cortisone injection leads to a finding that warrants surgical evaluation, you’re already in the right practice. Our sports medicine physicians and orthopedic surgeons work together and communicate directly.
We know when to stop When cortisone is no longer the right answer, we say so and tell you what comes next. We don’t continue injecting when the clinical picture has changed.
No hospital visit All injections are performed at our Upper East Side and Midtown offices. In-office procedure, same-day appointment, no recovery time.

 

The bottom line

Cortisone is a valuable tool. Used correctly, it can be the difference between completing physical therapy and not, or between needing surgery now and not for years. Used incorrectly (as a substitute for diagnosis, on the wrong condition, or too frequently), it delays the right answer and sometimes causes harm. New York Bone & Joint’s approach is to know the difference before we act.

References

A cortisone injection typically provides pain relief for anywhere from a few weeks to several months, depending on the condition being treated, the injection location, and the individual patient. For subacromial injections in shoulder impingement, relief commonly lasts 4–8 weeks. For knee osteoarthritis, studies show average relief of 4–12 weeks. [3] Duration tends to shorten with repeated injections, which is a signal that the underlying condition may be changing and warrants re-evaluation. When combined with a dedicated physical therapy program, relief can extend significantly beyond the initial injection period.


Generally, most orthopedic specialists recommend no more than 2-3 injections per year in the same joint, with at least 6–8 weeks between injections. This frequency limit exists because repeated intra-articular corticosteroid injections in weight-bearing joints have been associated with accelerated cartilage loss in multiple studies. [4] [5] More importantly, a pattern of frequent injections with shortening relief duration is a clinical signal that the underlying condition needs re-evaluation rather than more injections.


No, cortisone treats inflammation, not the structural or mechanical problem causing the inflammation. For purely inflammatory conditions like bursitis or synovitis without structural damage, cortisone combined with physical therapy can produce durable improvement. For structural problems such as rotator cuff tears, meniscus tears, labral pathology, or cartilage damage, cortisone addresses only the secondary inflammation, and the structural problem remains when the injection wears off. [1]


Yes for most targets: studies consistently show that ultrasound-guided injections achieve higher accuracy rates and better clinical outcomes than landmark-guided injections. [8] For deep structures like the hip joint, the subacromial bursa in a muscular shoulder, the plantar fascia, and the Achilles peritendinous space, ultrasound guidance is particularly important. New York Bone & Joint uses ultrasound guidance as the standard for injections where it improves accuracy.


Cortisone can help the bursitis and inflammation that accompanies a rotator cuff tear, but it doesn’t treat the tear itself, and repeated injections may impair healing if surgery is needed later. [10] For partial tears with significant impingement, a subacromial injection as part of a structured physical therapy program can be appropriate. For full-thickness tears in active patients, injection may provide temporary relief but is not a substitute for evaluation of whether surgical repair is indicated. The decision depends on tear size, your activity level, and whether the injection is part of a defined treatment plan or a substitute for one.


Yes, but cortisone can temporarily elevate blood glucose levels for 24–72 hours post-injection, so extra blood sugar monitoring is advised during that window. Inform your New York Bone & Joint physician about your diabetes and any current medications. The glucose elevation is typically manageable, but your endocrinologist or primary care physician should be aware if you require insulin adjustment. If your blood sugars are poorly controlled then see your primary care doctor before proceeding with the cortisone injection.


We recommend avoiding strenuous activity for 24–48 hours after a cortisone injection to allow the medication to settle at the injection site, after which normal activities can be resumed as tolerated. For patients whose injection is part of a physical therapy plan, physical therapy is typically resumed after 48–72 hours. Your New York Bone & Joint physician will give you specific guidance based on the injection location and your activity level.


Cortisone is an anti-inflammatory steroid that reduces joint inflammation; hyaluronic acid injections (viscosupplementation) are designed to supplement the natural lubricating fluid in a joint, primarily used for knee osteoarthritis. Cortisone typically provides faster relief but has documented frequency limits and cartilage risk with repeated use. Hyaluronic acid has a different mechanism and risk profile. New York Bone & Joint physicians will discuss both options and recommend the approach most appropriate for your specific condition and treatment goals.


For most orthopedic conditions, an appropriate trial of conservative treatment (including cortisone injection when indicated) should precede any surgical recommendation. Surgery becomes the right answer when conservative treatment has been properly administered and has not provided adequate relief, when there is a structural problem that cannot be addressed non-surgically, or when the natural history of the condition means delay causes harm. At New York Bone & Joint, this decision is made together with you after a complete evaluation. We will never recommend surgery without first establishing that non-surgical options have been exhausted or are genuinely not appropriate for your situation.


Medically Reviewed by Dr. Popovitz.

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