What are the key takeaways?
- Cortisone injections give real pain relief for about 70% of people with thumb arthritis, and it lasts typically 3-6 months.
- The procedure takes only a few minutes and most people feel only brief, moderate discomfort, not severe pain.
- Most doctors recommend no more than 2-3 injections per year to avoid cartilage damage.
- Injections work best with splinting and hand therapy, not by themselves.
If splinting and therapy do not give enough relief, your doctor may suggest a cortisone injection. It is one of the most common treatments for rhizarthrosis (thumb arthritis), and for many people it provides meaningful relief that lasts for months. Here is what you need to know, from the science behind it to what the injection feels like.
What are cortisone injections and how do they work?
Cortisone (corticosteroid) is a strong anti inflammatory medicine. When it is injected directly into the CMC joint (carpometacarpal joint), it lowers the inflammation that causes pain, swelling, and stiffness. Unlike pills that affect your whole body, an injection sends a high dose right to the joint.
The injection usually has two parts:
- A corticosteroid (such as triamcinolone or methylprednisolone), the anti inflammatory medicine
- A local anesthetic (such as lidocaine), provides immediate but temporary pain relief and shows the injection is in the right spot
What happens during the procedure?
The injection is usually done in your doctor’s office and takes about 5 to 10 minutes total:
- Positioning: Your hand is placed palm down on a table. The doctor finds the CMC joint by feeling the base of your thumb.
- Cleaning: The skin is cleaned with an antiseptic solution.
- Optional numbing: Some doctors use a cold spray or topical anesthetic before the injection.
- Injection: A thin needle goes into the joint space. You may feel pressure and a brief sting. The medicine is injected slowly.
- Aftercare: A small bandage is put on. You can usually drive home and resume light activities the same day.
Some doctors use ultrasound guidance to place the needle precisely in the joint. Research shows ultrasound guided injections have higher accuracy rates (95% vs. 75% for landmark guided), which may improve outcomes.
How much does it hurt?
This is the question most patients want answered first. It varies, but most people say it feels like:
- A brief sharp sting when the needle enters the skin (1-2 seconds)
- A feeling of pressure or fullness as the medicine goes into the joint
- Overall, it is uncomfortable but tolerable. Most rate it 3-5 out of 10 on a pain scale
- The local anesthetic starts working within seconds, and many people feel immediate relief
A common experience is that the first 24-48 hours after injection may be more painful than before. This is called a cortisone flare. It is normal and goes away on its own. Ice and over the counter pain medicine can help during this time.
How long does the relief last?
Clinical studies show the following pattern:
- Immediate relief (first few hours) from the local anesthetic, this wears off
- Full cortisone effect usually starts after 3-7 days
- Peak benefit usually at 2-4 weeks
- Duration of relief 3-6 months on average, though this varies widely
Some people get 6-12 months of relief, while others notice the effect fades after 6-8 weeks. A 2015 meta analysis found that about 70% of patients experience meaningful pain reduction after a CMC joint cortisone injection.
Risks and side effects
Cortisone injections are generally safe, but like any medical procedure they have risks:
- Post injection flare (common, 10-25%), temporary more pain for 24-48 hours
- Skin thinning or discoloration (uncommon) at the injection site, more common with repeated injections
- Infection (rare, less than 1 in 10,000), watch for increasing redness, warmth, and fever
- Tendon weakening (rare), a concern if the injection goes into a tendon rather than the joint
- Temporary blood sugar elevation, important for people with diabetes; talk with your doctor
- Cartilage effects, repeated injections (more than 3-4 per year) may speed up cartilage breakdown; this is why most doctors limit the number
How many injections can you have?
There is no strict rule, but most hand specialists follow these guidelines:
- No more than 2-3 injections per year in the same joint
- At least 3-4 months between injections
- If 2-3 injections provide diminishing relief, it may be time to discuss other options
- There is no strict lifetime limit, but the joint should be reassessed if injections stop working
An injection that gives good relief for several months shows the pain is coming from the CMC joint and buys time while you try other treatments like hand therapy and splinting.
Alternatives to cortisone
If cortisone injections are not right for you or have stopped working, other injections may help:
- Hyaluronic acid injections may give similar relief with fewer side effects; see our article on PRP and hyaluronic acid injections
- PRP (platelet rich plasma), there is growing evidence for longer lasting effects
- Surgical options, when all non surgical treatments have been tried; learn more in our surgical treatment guide
For a full overview of all non surgical treatments, visit our conservative treatment guide. To compare treatment approaches at different stages of disease, see our treatment comparison page.
Medical Disclaimer
This article was prepared by the Hand Health Medical Advisory Board for educational purposes only. It is based on current medical literature and clinical guidelines, but it does not replace professional medical advice. Every patient’s situation is unique. Please consult your doctor or hand specialist before making any decisions about your treatment. If you are experiencing severe or worsening symptoms, seek medical attention promptly.