Steroid injections: A guide for patients

Steroids used in the treatment of musculoskeletal pain are a potent anti-inflammatory. They are injected directly into the joint or other soft tissue to treat the symptoms. They are used to treat conditions such as joint pain, inflamed bursa, tenosynovitis (inflamed tendon sheaths), plantar fasciitis and neuromas (benign thickening of a nerve).

Anti-inflammatory steroids can be administered either orally or by injection. When taken orally they can have an effect on the normal steroid production of the body and lead to secondary effects. Anti-inflammatory steroids do not have an effect on gender hormones. When injected locally (one specific area) their action is only local, not throughout the whole of the body.

The beneficial effect of the injection can last for several months. It can help to reduce pain, swelling and stiffness and enable you to return to normal activities. You can have up to three injections in a year into one site. However, with repeat injections long term joint and soft tissue damage can result.

A steroid injection into a joint is associated with minimal pain. However, over the following 24 to 48 hours, pain and redness may be experienced from the injection site and or joint (steroid flare). This is not uncommon and it is nothing to be concerned about and if it does occur it is advisable to rest and take pain killers which you would normally take for a headache. This reaction is self-limiting (settles on its own accord). On rare occasions it can last up to seven days.

Following a steroid injection, it is advisable to rest for the first 24 hours. The flare up usually occurs within this period of time.

Specific complications following a steroid injection include:

• Pain from the injection site – medium risk
• Rupture of tendon / plantar fascia – low risk
• Localised de-pigmentation/ whitening of the skin – low risk
• Weakening of the ligaments around a joint. If this occurs around the toes, it can lead to a change in the position of the toe – low risk.
• Thinning of the skin – low risk
• Thinning of the fat pad on the sole of the foot – low risk
• Bruising, bleeding or nerve injury at the injection site – low risk
• Failure to improve symptoms – low risk
• In diabetic patients, corticosteroids can cause a temporary increase in blood sugar levels – low risk
• Allergic reaction: (anaphylaxis) is a medical emergency – usually occurs within minutes of the injection but may be delayed by a number of hours. If you develop any of these symptoms: tongue or lip swelling, difficulty breathing, an itchy rapidly spreading rash, then call 999 or attend accident and emergency (A&E) immediately – extremely low risk
• Infection: if the joint becomes hot, swollen, very painful or you start to feel unwell, please contact the Department or 111 out of hours - very low risk.