What is Steroid Injection Therapy?

Corticosteroid (steroid) drugs can be used to treat pain and inflammation, and certain types of arthritis. They can be given as an injection, at low doses, and are helpful in treating many joint and soft tissue problems.

The steroid is administered by injection into the joint or soft tissue. A local anaesthetic is often given  at the same time, which helps to reduce the discomfort for few hours and often helps with diagnosis. Some injections are given under ultrasound guidance.

How quickly will the injection work?

This varies with individuals but most people report improvements in their symptoms within 24-48 hours. However, it can take a few days to weeks for it to work in some individuals.

How long will the injection last?

As with all treatments, patients will have varying responses to steroid injections. Some patients will have a reduction in pain for only a few days, whilst others may have several months or long-term relief.

Is a steroid injection right for me?

Steroid therapy may not be suitable for you if you have:

• Heart failure
• Recent trauma to the joint being treated
• The presence of local or systemic infection or you are taking antibiotics
• A known allergy e.g. local anaesthetic, Latex
• A tendency to bleed more (due to medical conditions or various medication) particularly if you have an unstable INR
• Surgery pending in the joint to be injected
• Current or recent treatment with certain medication e.g. oral steroids, HIV medication
• Severe fear of needles
• Received a vaccination or have one planned within 2 weeks of your injection
• Under 16
• Pregnant or breastfeeding

Are there any risks to having an injection?

Risks associated with steroid injections are rare. Those most commonly reported, although still rare, associated with these types of injections are:

Infection

It is rare to have an infection after an injection. Symptoms may include redness, increasing warmth, increasing pain and if more serious a fever. Seek immediate (that day) medical attention if concerned.

Raise in blood sugar

Steroid injections can cause a rise in blood sugar levels for a few days in diabetic patients. Closer monitoring of blood sugars should be carried out and medical attention sought if unable to control.

Allergic reaction

This will normally happen within a few minutes of the injection. Symptoms may include a skin rash, difficulty breathing, swelling of face and/or tongue, itching and vomiting. Seek urgent/immediate medical attention.

Bleeding or bruising

This is more likely if you are taking medication such as aspirin or warfarin. This will normally settle with pressure. If you have any concerns, please seek medical attention. Your medication will be discussed prior to your injection.

Soft tissue damage / rupture

Steroid can weaken soft tissues such as tendons and ligaments. On rare occasions tendons/ligaments may rupture. Seek medical attention if you have any concerns.

Osteonecrosis

Very rare complication resulting in bone cell death which may cause joint damage.

Reduced immune response

This is temporary for 1 week to 2 months. This could mean you are more vulnerable to illness including COVID-19, which could result in greater complications such as ventilation or death.  

Please discuss any of these factors with your clinician. 

Side effects associated with steroid injections are rare. The most common side effects are:

Steroid flare

Some patients experience an increase in pain after injections. This can be quite severe but settles after a day or two. Rest and simple pain killers (such as paracetamol) often help.

Skin changes

Occasionally there may be some skin discoloration/lightening (depigmentation), thinning of the skin, or fatty atrophy at the injection site. This may or may not resolve over time and is more notable in people with darker skin.

Facial flushing

Some patients experience facial flushing soon after an injection and can last up to 48 hours.

Menstrual Cycle

There may be delay or change the menstrual cycle following injection. This will normalise by itself.

If you experience any problems that cause you undue concern, please contact your treating consultant's secretary. Alternatively contact your GP or A&E department if you consider the problem to be urgent.

What should I do after the injection?

• It is best practice to rest for about 30 minutes before leaving the hospital especially if it's your first injection.
• It is advised that you do not drive for a few hours following an injection that involves a local anaesthetic.
• You should try and rest the area and avoid strenuous exercise for a few days after the injection