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Steroid Injection Information

The aim of this information sheet is to answer  some of the questions that you may have regarding your corticosteroid injection. It explains the benefits, risks and possible alternatives.

What is a corticosteroid injection?

A corticosteroid or cortisone injection is an anti-inflammatory medicine which can be injected directly into the tissues that are causing your symptoms. This allows it to act directly in the area where your problem is occurring.

Steroids are produced naturally within the body and are essential for good health. The steroids used for injections are similar to those produced naturally by your body. You will usually be having a steroid called either: triamcinolone (Kenalog) or  methylpredisolone (depomedrone), which have longer-lasting effects than naturally produced steroids.

What are the benefits?

The injection can help reduce pain, swelling, stiffness and inflammation. This may lead to an improvement in your symptoms. It can also aid return to more normal activities and function by breaking the cycle of pain and inflammation.  In some conditions injections like this can lead to “cure”. In other cases there may be an improvement or temporary relief of symptoms.

What are the alternatives to a steroid joint injection?

The alternatives to steroid joint injections will depend on what is causing your pain. Alternative treatments include steroid tablets, anti-inflammatory drugs, painkillers and physiotherapy. Your doctor/surgeon will talk to you about the options available to you. In general it is preferable not to have steroid tablets if an injection is an option as the effects are more localised.

What are the risks?

It is uncommon to get any significant problems after an injection. The majority of people will have some discomfort during and after the injection together with slight swelling.

Other potential risks include

Infection: very rare probably 1 in 15000. If the area becomes hot painful and swollen for more that 24 hours, or if you feel generally unwell you should contact your Doctor/Surgeon immediately. If they are unavailable then you should seek advice from you General Practitioner of the Accident and Emergency Department.

Risks Continued…

Allergic reaction to the drug: this is very uncommon. You will be asked to wait for 10 minutes after the injection to check for any reactions

Skin depigmentation, dermal atrophy, adipose atrophy: the skin around the injection site may become thin or pale and sometimes the “fatty” layer under the skin shrinks away. If this occurs it usually improves over time but this can take many months.

Nerve injury: this may cause pain during the injection or rarely long lasting effects or nerve damage. Due to their close proximity to nerves, these injections can sometimes cause temporary muscle weakness of the arm or leg. Occasionally an injection around the hip may cause weakness in the leg that requires you to use crutches temporarily.

Tendon Injury: depending on the site of, and reason for the injection.

Flare of symptoms and increase in pain for 24-48 hours after the injection may occur. This is usually treated with analgesics, ice to cool the area and non-steroidal anti-inflammatory NSAID’s tablets if you are able to take them. Not everyone is able to take NSAID tablets such as ibuprofen/nurofen.

Increased blood sugars in diabetic patients: this may last for over 7 days with significant elevation of blood sugars

Facial flushing: particularly in ladies

Slight vaginal bleeding / menstrual irregularities

 

You should not have the injection carried out if you:

  • Have any infection in the area or anywhere else in your body.
  • Are allergic to local anaesthetic or steroid.
  • Feel unwell.
  • Are due to have surgery in that area soon.
  • Are pregnant or breast feeding. You may still be able to have the injection depending upon the reason. Very small amounts of the steroid enter breast milk.
  • Have poorly controlled diabetes.
  • Are taking any immunosuppressant medication
  • Do not want the injection.

What happens during the injection?

The benefits and risks of the injection will be explained to you in detail. You will then be placed in a comfortable position. The skin is cleaned with an alcohol and antiseptic spray. A needle is gently positioned into the affected area and local anaesthetic solution is injected through the needle. Once the area is “numb” the corticosteroid will be injected. Pressure will be applied to the area to minimise bruising and an adhesive plaster will be applied. You will be kept for approximately 10 minutes after the injection to watch for any reaction.

What happens after the procedure?

The local anaesthetic used in the injection will begin to wear off after a few hours. You may need analgesics or simple pain killer. Use ones that you know agree with you. The steroid usually starts to work after 24–48 hours, but it may take over a week. The effect of the injection varies from person to person and usually continues to last for about six weeks. This does not necessarily mean that you will need a second injection, so long as you follow the advice given to you after the injection.

What do I need to do after I go home?

You will often be advised to rest the area for 24-48 hours after the injection. This does not usually mean total rest, but refraining from activities that make your pain worse, after which you should try to gradually return to full function. Heavy lifting should be avoided for approximately a week after the injection or longer in certain circumstances – you will be advised if this is necessary. This is to maximize the benefit given by the injection. You may also be shown some exercises to do whilst you are in the clinic, or referred for physiotherapy treatment. If you are having other medical treatment within six weeks, you should tell the treating clinician that you have received a corticosteroid injection.

Will I have a follow-up appointment?

You may be asked to attend a follow up appointment 4-6 weeks after your injection to check your progress. Occasionally, more than one injection is needed and this can be discussed at this appointment.

Not everyone needing an injection requires a follow up appointment. Often your surgeon will ask you to telephone their secretary after 6 weeks if the injection has not been successful to arrange either another injection or an alternative treatment.

If the injected area/site becomes hot painful and swollen for more that 24 hours, or if you feel generally unwell you should contact your Doctor/Surgeon immediately via the Winterbourne Hospital switch board on 01305263252. If they are unavailable then you should seek advice from you General Practitioner of the Accident and Emergency Department.

For more help and guidance, please contact

The Winterbourne Hospital

Herringston Road
Dorchester,  Dorset DT1 2DR

Phone: 01305 263252

Mr Crook’s Secretary : Katie Reed on 07964 817 242

Mr Walsh’s PA : Sandra Pepper on   07980 562 473

 

NHS Direct 24 hours a day

Phone: NHS 111

Website: nhsdirect.nhs.uk

 

For more help and guidance continued 

The Patients Association

Helpline: 0845 6084455
Website: patients-association.com 

The Patients Association
PO Box 935
Harrow
Middlesex HA1 3YJ

 

The British Society for Surgery of the Hand
Website: bssh.ac.uk

Royal College of Anaesthetists: Anaesthesia Explained

Website: youranaesthetic.info

 

Information Sheet Compilers

Mr Sean Walsh - Consultant Orthopaedic Hand & Trauma Surgeon

Maree Dethick - Jones - Senior Hand Therapist

Laura Putnam - Hand Therapist