This leaflet is designed for people considering a corticosteroid injection. Corticosteroid injections can be a quick and effective treatment for pain and inflammation, although the benefits are temporary. They are usually used in combination with a wider rehabilitation program.
What are steroids and what do they do?
Corticosteroids are an artificial version of cortisol, a hormone made by the body which is not the same type of steroid some body builder’s use. The main use of corticosteroid medications is to reduce inflammation that can cause pain.
They are used for treating inflamed joints (e.g., arthritis) or soft tissue injuries (e.g., tendonitis or bursitis) and can help reduce pain, swelling and stiffness, sometimes within a short space of time.
The Procedure
The area to be injected is identified and thoroughly cleaned with antiseptic solution or alcohol wipe and can be made numb with a freeze spray.
The medication will be drawn up into a syringe and a needle attached. This will then be inserted into the skin. Initially, an attempt to withdraw fluid will be made to make sure the needle is not in a small vein and then the medication, which may be a mixture of steroid and local anesthetic will be injected. In some circumstances, when using a combination of particular drugs, the syringe will need to be changed to administer the second drug.
Before the injection, you must tell the health care professional if:
- You feel unwell or have any form of infection like a chest or water infection.
- You have had a recent accident or injury, causing bleeding.
- You are allergic to any medications, like anaesthetics or if you have had a bad reaction to a steroid in the past.
- You have a prosthetic joint like a hip or knee replacement, or have any pins, screws or plates in your body.
- You have diabetes, epilepsy, high blood pressure or problems with your liver or kidneys.
- You take anticoagulant medication like Warfarin or heparin.
- You have a bleeding disorder like haemophilia.
- You take oral steroids like Prednisolone.
- You have concerns about an injection or do not want and injection.
- You have had an injection in the last 4 months, or more than 3 injections into the area to be injected.
- You are pregnant or breast feeding.
- You are due to have elective surgery within 3 months of having the steroid injection.
- You have had / or are having a vaccination. Please advise the clinician the date of this.
Possible side effects of steroids
As with all medications, there are potential side effects to steroid injections but these are very rare. These include:
- An allergic reaction to the medication, Elastoplast or antiseptic applied to the skin
- Increased pain in the area of injection for up to 24-48 hours
- Facial flushing for up to 48 hours
- Infection
- Bleeding or bruising can occur at the site of injection
- Short term alteration to blood sugar levels, especially important if you are diabetic
- Short term increase in blood pressure, especially important if you have high blood pressure
- Adrenal gland suppression / insufficiency which can effect cortisol levels in the body
- Temporary suppression in lactation if breastfeeding
- Changes to your vision such as blurred vision – speak to your specialist if this happens
- Changes to the colour of your skin around the injections site.
- A loss of fat around the injection site.
- A lump may form at the site of injection.
- Damage to soft tissue, including rupture to tendons.
- Repeated injections can cause bone damage and deterioration, which is why no more than 3 injections are normally given to one area. This can lead to progression of osteoarthritis.
- There is a possibility that a steroid injection may have the potential to affect your immune system resulting in immunosuppression. There is a chance that this may affect yourability to fight an infection.
- Possible changes to menstrual cycle and vaginal bleeding
Aftercare following the steroid injection
To get the most from the injection, you should rest the area injected for 7-10 days. This is not to say don’t move with the area, but avoid higher levels of activity such as sports and DIY etc. Discuss this with your health professional. We ask you to stay in the waiting area for 30 minutes after the injection so that you do not have any immediate reaction to the medication. Depending on the site injected, we may advise that you do not drive immediately after the procedure.
If you start feeling unwell or the area injected becomes hot, red, or swollen please seek medical advice. If you have a severe adverse reaction to the injection, go to your local Accident & Emergency department.
Alternative treatments
You do not have to have a corticosteroid injection. Discuss with your GP or Consultant about taking non-steroidal anti-inflammatory drugs (NSAIDS) like ibuprofen. There are options of Physiotherapy or not having the injection.