Steroid injections are used to reduce pain and inflammation for many musculoskeletal disorders such as osteoarthritis and soft tissue injuries. Here in Oxford Circus Physiotherapy, we perform the injection using ultrasound guidance, in order to place in the medicine in the exact area of the problem.
The medicine corticosteroid, is a widely used substance that mimics the effect of a naturally occurring steroid which is made in our bodies. It is not the same substance that some body builders use, so will have no effect on muscle mass or weight gain.
How do I know if a steroid injection is right for me?
Your clinician will take a detailed history and perform a full assessment to establish the diagnosis and cause of your problem. They will then discuss with you all of the treatment options, including steroid injection.
There are certain medical conditions that affect the safety or suitability of having a steroid injection. Your clinician may need to obtain further information from your GP or specialist if you have diagnoses such as diabetes, unstable blood pressure, HIV, or take blood thinning medication. Unfortunately, if you are pregnant, we are unable to offer steroid injection due to the unknown effects on your baby. If you are breast feeding, it has been shown to be safe to have a steroid injection. More information regarding this is available from the Breast Feeding Network UK. If you have any questions then please discuss this with your clinician.
What should I expect during the injection appointment?
Your clinician will reconfirm the diagnosis and safety of administering the steroid injection. Once you have given consent and agreed on the site and dosage of medication, you will be made comfortable either lying or sitting up.
A combination of steroid and if appropriate, local anaesthetic, will be injecting under ultrasound guidance into the affected area. You may feel some discomfort during the injection, but most procedures and quick and easy so pain may not be as bad as you expect. The injections do not take long, but you may be asked to wait for 15-20 minutes after the injection, to monitor for adverse effects.
What to expect after having a steroid injection?
If you have had local anaesthetic as part of the injection, you may feel several hours of pain relief. Once this has worn off, you may feel a residual ache from having had the procedure. It is perfectly fine to take painkillers such as paracetamol, or use ice, but do not take anti-inflammatories (NSAIDs) such as ibuprofen or naproxen.
Over the next few days, the steroid will start to take effect, but you may not feel the full benefits for a couple of weeks. We also recommend that you avoid strenuous activity of the affected area for a few days, or up to two weeks if your injection has been near a tendon. This allows the medication to maximise its effect, but also prevents injury while the medication is acting. Your clinician will provide specific advice on post injection care and rehabilitation, and you will also be sent a post injection care information.
How many injections will I need?
Most people find one injection is enough. If you have some improvement but not complete, a second injection may be suitable. We recommend waiting at least a month in between steroid injections, and not having more than three in 1 area in a year. If you have a condition such as osteoarthritis and do not intend/are not able to have surgery, many people have injections to maintain function and quality of life. However, there may be alternatives to steroid such as Hyaluronic acid which your clinician will discuss with you.
What are the risks and Possible side effects?
- Post injection flare: A minority of people find a temporary increase in pain for 24-48 hours post injection. This is entirely normal and can be helped with paracetamol, rest and ice. We also suggest avoiding driving to/from your appointment, in case you have any post injection soreness.
- Skin depigmentation: Steroid injections can occasionally cause change to the colour of the skin, especially if the site of injection is close to the surface. Changes are often temporary but can be permanent.
- Local fat atropy: It is not common, but sometimes a steroid injection can induce a small loss of fatty tissue in the skin around the area of injection. This can lead to a small indentation in the skin. This is a rare occurrence.
- Infection: Due to the nature of the needle breaking the skin, there is a very small; chance of infection (1:50, 000). All our injections are done using sterile equipment, with the upmost attention paid to maintaining high standards of cleanliness and safety. If the injected area becomes hot/swollen/painful, you should seek urgent medical attention.
- People with diabetes are advised to monitor their blood sugars closer than usual for one to two weeks post injection. This is because steroid medication can occasionally (and temporarily) cause blood sugars to fluctuate. This is why it is important to discuss your diabetes with your clinician, and also let your GP know that you intend to have a steroid injection. For type 1 diabetes, if your HbA1C is above 8%, you will need to speak to your GP first to confirm it is safe to have the injection.
- Facial flushing: Some people find their face feels warm and flushed for a few hours post injection. You will not feel ill, and this side effect will usually wear off in the same day.
- Menstruation: there is some research to indicate a possible temporary change in menstruation, or some blood spotting, post injection. Given the relative low doses of the steroids that we use, this is unlikely, but worth knowing,
- Anaphylaxis: Some people can be allergic to medicines, so we will always confirm your medical history and safety of administering the injection first. You will be asked to wait for 15-20 minutes post injection in order to monitor for adverse effects.
- Tendon rupture: if your injection has been near the tendon, you are advised to avoid heavy lifting/loading for two weeks, to reduce the risk of tendon rupture.
- Joint changes: multiple steroid injections into a joint such as a knee can cause damage to the internal structures. This is why alternatives may be offered if you are requiring frequent steroid injections.
I take other medicines. Can I still have a steroid injection?
The majority of patients will still be able to have a steroid injection if they take other medicines. There are a few exceptions that the clinician must first check before it is safe to proceed. If you have diabetes that is not well controlled then we first need to check with your GP. Patients having treatment for cancer or HIV may require your therapist to first check with your GP or treating consultant as well. If you are taking a blood thinning drugs we will check the type and timing of your medication before any injection.
Potential side effects of local Anaesthetic (Rare):
- Light headedness/dizziness/fainting/drowsiness
- Blurred/double vision
- Lowering of the heart/breathing rate
You may be asked to remain in the clinic waiting area for up to 20 minutes following the injection to allow observation of possible adverse reactions.