Steroid Injections

Corticosteroids are the body’s natural anti-inflammatory products. The body naturally produces many steroids, such as Cortisone, to reduce inflammation and promote healing. Corticosteroid injections can often give rapid and effective reduction in pain and inflammation; however, as with all injection treatments relief is not permanent unless the reason for the inflammation is dealt with. We offer steroid injections for multiple problems with a focus on pain reduction and increased mobility.

The injection gives a small targeted dose of steroid into the affected area of pain. In a joint for example most of the steroid would stay at the target site with very little leakage throughout the rest of the system. Tablets are a scatter gun action taking very high doses that reach everywhere in the body.

Following the injection, the inflammation within the joint space, tendon or bursa takes 2 – 10 days to reduce after the direct injection. A single injection may be sufficient to alleviate your pain, however some chronic conditions can require multiple injections. Steroid injections are always used in conjunction with exercise rehabilitation.

Once the pain has reduced, retraining and normalising movement & power is key to long term success. The steroid allows a window of opportunity for rehabilitation and exercises. There is also the added benefit of pain relief which can help with mobility, sleep quality, mental health and ability to do the exercises.

These are the injections that we can undertake in clinic:

Hip: Trochanteric Bursitis / Greater Trochanteric Pain syndrome (GTPS)
Knee: Knee joint 
Shoulder: Frozen shoulder, Subacromial bursitis/Impingement
Elbow: Tennis elbow, Golfers elbow
Wrist / Hand: De Quervains, Trigger finger

As we nearly always use a local anaesthetic at the time of steroid delivery, you will feel an immediate improvement.  This initial numbing or pain reduced state will usually wear off after a couple of hours but is a vital part of the diagnostic process. It will usually takes 2-10 days before the full effect of the steroid can be felt and we expect pain to be significantly reduced typically within 2 weeks after the injection.

We will ask you to wait 20 minutes post injection in the clinic to ensure your recovery is as expected and if you are driving home we would ask you to wait as long as required to ensure you are safe to drive. Ideally have someone else pick you up post injection if in a vehicle. We suggest relative rest to the area injected for a minimum of 48 hours and expect you to use common sense around this.

While there are side effects to steroids, these are usually in much long term courses of tablets and not a one off injection . We generally use long acting steroids that ideally work in your body for 3-4 months increasing the chance of a beneficial effect. Possible side effects include:

• a temporary flare up of your pain after the injection for 24-48 hours
• possible redness/ facial flushing 
• People with diabetes may notice some change to their blood sugar control (this is usually short term and does not usually need to be adjusted for).
• Some female patients may notice a change to their menstrual cycle, with some spotting 
• Skin depigmentation (lose colour), though this is purely a cosmetic side effect and will not affect the function of the tissues. 
• These risks listed above will be broken down and expanded on below.
• Steroid is an auto immune drug and can dampen the immune response so has to be used with caution where immunity is already weaker.
• Any injection also has the potential to introduce infection, but this is exceptionally rare. 
• If a local Anaesthetic is used alongside the steroid then there is a very small possibility of an anaphylactic reaction, this is very rare

Generally, the risk of side effects is thought to increase in line with higher dosages, and the clinical guidelines are to only use the lowest possible dose to achieve the desired clinical outcomes. 

​​We will discuss through these prior to undertaking an injection and are happy to discuss any questions you have regarding the side effects or any other question regarding the injection prior to undertaking.

Infection following a steroid injection is rare. We take your health extremely seriously and will have taken every step to reduce the risk of infection. Huw injects within his NHS practice and adopts the same procedures and steps to ensure we adhere to a strict set of hygiene and infection control measures. If after the injection the region injected becomes painful, red , warm and swollen and/or you feel feverish and unwell, you are advised to seek medical attention immediately via 111, GP or A&E if you are unable to contact us. 

Generally, pain killers will not interact with the steroid but prior to injection we would carefully discuss all your medication to ensure there are no interactions that would concern us. Steroid is exceptionally safe and only contraindicated in very rare circumstances in respect to other medications. We would need to know if you are on anticoagulants (blood thinners), before we inject, though many of the newer drugs do not interact with injected steroids. Usually, the contraindications are about your medical history e.g. an active cancer, uncontrolled diabetes, epilepsy which may mean we are unable to inject.

A slight flare up in pain within the first 24-48 hours after their injection is common in around 20% of procedures but will ease after this.  It will often feel like your pain has just gotten a little worse, but this is a temporary issue that will pass. We advise taking simple over the counter pain medication or continue with the medication you were taking before until the steroid kicks in which is usually between 2-10 days post injection. Ice or heat to the area may help as well.

Although it may seem an obvious choice to have a steroid injection to reduce pain while waiting for a knee or hip joint replacement, it is not recommended. Many Orthopaedic surgeons will not operate within 3-6 months of someone having a steroid injection into the same joint, as there is some research suggesting it may increase the risk of post op joint infection, which is a serious complication for joint replacement surgery.

We do not offer spinal, or "nerve root" injections for sciatica/leg pain. These are highly specialised injection that usually need to be carried out under x-ray guidance and are currently rarely performed outside of a hospital setting.