Your cortisone shot might not be working for bursitis because it missed the target area, the pain is from another issue like tendon damage (gluteal tendinopathy) misdiagnosed as bursitis, the inflammation isn't the main problem (e.g., advanced arthritis), or you've had too many injections, leading to resistance. The shot only treats inflammation, not structural problems, so if the root cause isn't inflammation or the injection wasn't precise, it won't provide lasting relief.
If the first cortisone injection doesn't provide pain relief, your doctor may try a second injection four to six weeks later. Albert Einstein said it best. Insanity is doing the same thing over and over and expecting different results. Regrettably, this is the approach adopted by many providers and must be avoided.
The effect of the injection will start usually 5 to 7 days after the injection. This can decrease your symptoms. At some point, most people feel less or no pain in the tendon, bursa, or joint after a steroid injection. Depending on the problem, your pain may or may not return.
Another possibility is that inflammation is not actually the source of your discomfort. Cortisone's role is to reduce inflammation, but if your pain is caused by something else—such as structural joint damage, nerve irritation, or advanced tissue degeneration—the shot will not provide the relief you were hoping for.
If bursitis is severe or keeps coming back, the inflamed bursa may need to be surgically drained or even removed (but this is rare).
Mild cases typically resolve in 2–4 weeks with proper rest and treatment, while moderate cases may take 2–3 months. Severe or chronic bursitis can last 6+ months. Knee and elbow bursitis often heal faster (2–4 weeks), while shoulder and hip bursitis may require 6 weeks to 6 months for full recovery.
Doctors may recommend over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, to reduce inflammation in the bursa and tendon and relieve pain. These medications are typically recommended for a few weeks while the body heals.
Consultation with a pain management specialist: For chronic, difficult-to-manage pain that hasn't been relieved by an ESI, a healthcare provider may refer the patient to a pain management specialist who can provide additional treatment options and work with the patient to develop a comprehensive pain management plan.
Compared to cortisone injections, PRP therapy offers several advantages: Reduced risk of side effects: PRP is derived from the patient's own blood, minimizing the risk of allergic reactions or other adverse effects.
Cortisone shots commonly cause a short-term flare in pain, swelling and irritation for up to two days after the injection. After that, the pain, swelling and irritation should generally lessen. The pain relief can last up to several months.
How many cortisone injections can I have for bursitis? Doctors typically recommend no more than 3-4 injections per year to avoid potential side effects. Are cortisone shots a permanent solution for bursitis? No, cortisone injections provide temporary relief.
Usually, rest is all you'll need to treat trochanteric bursitis. Avoid the activity or positions that irritated your greater trochanter bursa. Taking a break from activities that put pressure on your hip will give the bursa time to heal.
How long does the steroid injection take to work? This varies from person to person. The effects can be immediate but can take 2 - 4 weeks to work. Most commonly after 3 - 10 days you should feel relief.
In the early stages, the pain is usually described as sharp and intense. Later, the pain may become more of an ache and spread across a larger area of the hip. Typically, the pain is worse at night, when lying on the affected hip, and when getting up from a chair after being seated for a while.
If you continue to have bursitis pain at the hip that has not improved despite extensive treatment, you may have a tear of a muscle located next to the bursa called the gluteus medius.
With rest and dedicated self-care treatments, bursitis pain can diminish after a few days or weeks. But reoccurring flare-ups can occur, especially if the habitual movements that caused them aren't adjusted. In chronic cases, bursitis can last months or years.
Because PRP therapy comes with fewer risks, helps boost healing, and can provide more permanent pain relief, we often recommend it over cortisone shots for overuse injuries. However, every case is unique, and what we recommend for you will depend on your individual situation.
While there's no single "strongest," Omega-3 fatty acids (from fatty fish) and curcumin (from turmeric) are consistently cited as highly potent natural anti-inflammatories, alongside powerful antioxidants from fruits and vegetables like blueberries, plus herbs like ginger and garlic, all working to reduce inflammation pathways. A comprehensive anti-inflammatory diet emphasizes these foods, though Omega-3s and curcumin often stand out for their significant impact.
Long-Term Use Risks Long-term use of oral steroids can lead to more severe health complications, such as osteoporosis, adrenal insufficiency, or diabetes. In contrast, corticosteroid injections often have fewer long-term risks when used appropriately.
The National Institute for Care and Excellence (NICE) guidelines recommend no more than 4 steroid injections into any 1 joint per year. With this in mind, we tend to allow at least 3 months between injections.
Some patients do not experience pain relief with cortisone treatments. If the first injection doesn't provide pain relief, your doctor may try a second injection four to six weeks later. If there's no improvement after the second injection, a third injection is not recommended.
The rate of absorption can vary depending on the type of corticosteroid used and the site of the injection. Once absorbed, the drug's concentration in the affected area decreases over time, leading to a reduction in its anti-inflammatory effects.
Hip bursitis is often worse at night, when lying down puts added pressure on the pelvic area. Rising from a chair or from a squat, climbing stairs or walking a long distance can also trigger the pain. Diagnosis begins with a physical exam, and it may also involve imaging tests.
Activities or positions that put pressure on the hip bursa, such as lying down, sitting in one position for a long time, or walking distances can irritate the bursa and cause more pain. It is also important to learn the hip bursitis exercises to avoid making the condition worse.
If symptoms of bursitis or tendinitis persist despite medical treatment and interfere with your everyday activities, NYU Langone doctors may recommend surgery.