What exactly is cortisone?  It is a type of corticosteroid.   Corticosteroids are a class of chemicals naturally produced in the adrenal cortex (adrenal glands above the kidneys) that are used to regulate multiple body functions.   The cortisone in cortisone shots are analogues (molecularly identical) of these hormones that are synthesized in laboratories.

According to Medicinenet,

Corticosteroids can be taken by mouth, inhaled, applied to the skin, given intravenously (into a vein), or injected into the tissues of the body. Examples of corticosteroids include prednisone and prednisolone (given by mouth), methylprednisolone sodium succinate injection (Solu-Medrol) (given intravenously), as well as triamcinolone, Kenalog, Celestone, methylprednisolone (Depo-Medrol), and others (given by injection into body tissues).

Corticosteroids affect a number of physiological responses including inflammation modulation, immune response, carbohydrate metabolism, protein catabolism (breakdown), stress response, immune response, and behavior/mood.

Cortisone shots for pain reduction have powerful anti-inflammatory capabilities, which is why they are a popular with orthopedic doctors in the treatment of injuries and joint pain.   Cortisone shots, when they work, act almost instantaneously.  They reduce pain by reducing the inflammatory response around the localized injection.  Cortisone shots also usually include an anesthetic drug such as lidocaine.

Side effects can include redness and temporary increase in pain, and dermatological effects like skin discoloration (especially in dark-pigmented patients).

Severe side effects from prolonged steroid use or large doses can include hyperglycemia, insulin resistance, diabetes mellitus, osteoporosis, cataract, anxiety depression, colitis, hypertension, seizures, fainting, peptic ulcers, erectile dysfunction, hypogonadism, hypothyroidism, increased menses, and retinal damage.

Kenalog (Triamcinolone) is a type of corticosteroid that is used to treat inflammation; particularly inflammatory skin diseases like lupus; allergies, rhinitis, and bronchospasm.   It is known to cause plenty of undesirable side effects especially dimpling/pitting at the injection site.   Women especially are known to  get terrible side effects from Kenalog injections, notably prolonged/ painful menstrual cycles.

Previously I related a personal experience where, due to the urgency of the situation, I decided to get a cortisone shot for  severe  neck pain and spasm (which I found out later was hyperkalemic muscle paralysis and did not involve inflammation).  I had three Kenalog injections along my left upper trapezius muscle, about a 5 mL dose.  Normally I avoid taking medications and injections for pain as much as possible, but I was scheduled to drive a 400 mile trip the next day and needed immediate relief.

Well, it turned out to be a very bad experience.   The shot atrophied the muscle, and now I am unable to raise it above shoulder level from the side.   The doctors I consulted with were uncertain of the long term prognosis.   I was advised to get physical therapy (which I have been doing myself) to encourage the muscle to regain its functionality.  However, it doesn’t appear to be changing.  An ominous fact I learned during my research of corticosteroids is that protein catabolism (breakdown of protein into its amino acids components)  is one of the functions of natural corticosteroids.  Could it be that the Kenalog shot “dissolved” some muscle tissue?  I certainly hope that is not the case.  If it were, it is not possible to rebuild that muscle tissue through weight lifting, as muscle hypertrophy from weight lifting works for existing muscle tissue only.

The experience was so bothersome that I decided to make a case study out of it for readers of this blog, and hopefully save someone from going through this awful experience.  Before you get a Kenalog injection, make sure you know what you are getting into.  My advice, skip it— the problems it causes appear to outweigh the benefits (see this internet message board on muscle atrophy from Kenalog injection).  Instead, try less invasive procedures appropriate for your condition such as massage, chiropractic, acupuncture/cupping, botanicals/herbs, laser treatment, ultrasound, traditional Chinese medicine, gluten-free diet, ketogenic diet, fasting, juicing, and detox/cleanses.