Corticosteroid Injections

Steroid injections do not change the underlying condition or problem with your painful joint or damaged tissue, but they can be very beneficial at breaking pain cycles and managing degenerative conditions. They provide a very powerful anti-inflammatory effect that can allow better compliance with physiotherapy and other management strategies.

Steroid injections can be very helpful in managing a number of common musculoskeletal conditions. Including but not limited to:

• Osteoarthritis
• Rheumatoid arthritis and other types of inflammatory arthritis
• Gout
• Tendon-related issues of the upper and lower limbs
• Bursitis of the upper and lower limb
• Frozen shoulder
• Carpal tunnel and entrapment neuropathies
• Trigger finger/thumb

Your physician or healthcare professional will discuss with you what to expect from a steroid injection and whether or not this type of treatment is appropriate for you. If you have any questions at any point, please raise any concerns with us. We will need to obtain your consent before having the procedure to make sure you are fully informed of the potential risks and benefits.

You will be asked, but it is also important you make our team aware if any of the following apply, as this may increase your risk of complications with an injection.

• You take medicines that thin your blood, such as warfarin. These increase your risk of bleeding into the joint (haemarthrosis). Most patients are suitable if they have a recent INR which is within normal ranges.
• Certain conditions that affect the natural ability of the blood to clot, such as haemophilia.
• If you have poorly controlled diabetes, as the steroid may increase your blood sugars for several days to a couple of weeks after.
• You have a known allergy to local anaesthetic or steroids in the past.
• If you have an active infection locally or systemically, as steroids are an immunosuppressant medication which can exacerbate symptoms.
• If you’re pregnant or breastfeeding.

You don’t usually need to make any special preparations before having a steroid injection, but we will need access to the painful area, so comfortable and easy-to-remove clothing is helpful.

We also recommend that you do not drive immediately after the injection where possible, as this may affect your insurance policy if you were to have an accident. You will need to rest the joint for a few days after the procedure.

If you have local anaesthetic, the pain will likely improve within a few minutes. The effects of the local anaesthetic will wear off within an hour or so, and some patients may require oral painkillers for a short period of time while the steroid starts to work. The steroid typically takes 72 hours before it has a therapeutic effect but can, on occasion, take a couple of weeks before you notice a difference in your symptoms.

You will be asked to wait around in the clinic for a short period of time to make sure you feel ok. This is usually 10-15 minutes after this time; once you feel ready, you are able to go home.

Side effects are the unwanted but usually self-limiting/temporary effects of having a steroid injection. Potential side effects include

• Increase pain and swelling in the joint or area known as a ‘post-injection flare’. This usually settles within a couple of days but can sometimes last longer.
• Facial flushing is more commonly seen in females but will typically resolve with a few days of the procedure.
• If you have periods, a steroid injection can temporarily affect them. It is important, however, that you make your GP aware of any changes and not assume this is related to the steroid injection.
• Temporary increases in your blood pressure and blood sugar levels. We do always advise, where possible for diabetic patients to monitor their blood sugars following a steroid injection
• Thinning or changes in the colour of your skin around the injection site are known as fat atrophy and depigmentation. More commonly seen with superficial injections around the wrist/hand and foot/ankle. It can improve with time, but the changes can be permanent, though this is rare.

Complications are more serious side effects that need immediate medical attention during or after the procedure. Serious complications are very rare but include:

• An infection within the joint or soft tissue surrounding it. If the pain in your joint suddenly gets worse and your joint feels hot, swollen and warm to the touch, accompanied by you feeling unwell, you should seek urgent medical advice, typically from AE. They happen in about 1 in 3,000 to 50,000 people.
• Anaphylaxis is a very rare allergic reaction to the medication used in the injection. You will be asked to wait around after the procedure to make sure you feel well before you leave. Symptoms would typically start within a few minutes of having the injection, and the team have lifesaving drugs available should the need occur.
• Research has shown that steroid injections can weaken and soften tendons and articular cartilage, which may result in these structures being more susceptible to tearing or developing accelerated osteoarthritis. Typically, it’s more of an issue with repeated steroid injection into the same location.

If you can’t have or don’t want a steroid injection, there are alternative injectable options which could be appropriate depending on your specific condition. (Please see our other injectable treatment pages). On top of this, there are also oral medications that can be taken to reduce symptoms, such as painkillers and anti-inflammatory medications.

Physiotherapy will have likely been discussed prior to injection options where appropriate but alone can have pain-relieving effects through increasing tissue capacity and tolerance, avoiding the need for pharmacological intervention.