Integrated Musculoskeletal Service Steroid Injections

This leaflet is designed to give you some information to help you prepare for your steroid injection and to give you some idea of what to expect during and after your injection. If you then have any questions you can ask the clinician who does the injection. 

What is a steroid injection?

Steroid injections, also called corticosteroid injections, are anti-inflammatory medicines used to treat a range of joint and soft tissue conditions. This includes osteoarthritis, frozen shoulder, bursitis, trigger finger, carpal tunnel syndrome, neuroma and plantar fasciitis.

How steroid injections work?

Steroids are a manmade version of hormones normally produced by the adrenal glands, 2 small glands found above the kidneys.

When injected into a joint or soft tissue, steroids reduce redness and swelling (inflammation).  This can help relieve pain which can make it easier to cope with your daily routine and reduce the need for painkillers for pain relief.

Steroid injections are different from the anabolic steroids used illegally by some people to increase their muscle mass. 

How long will it take to work?

The injections normally take a few days to start working, although some work in hours.  In the first 24 hours after injection you may feel your pain gets worse but it should improve over the next 2 to 3 days.

Will the injection hurt?

You may have some discomfort during the injection.

For some conditions, steroid injections may be mixed with a local anaesthetic and this can help to relieve discomfort immediately after your injection.  However, the local anaesthetic will start to wear off after a few hours. Your clinician can advise you on what injection is appropriate for your condition.

How long will it relieve my pain?

This can vary but can last from a few weeks to several months.  For some, there may be no relief from symptoms.

What preparation will I need?

Your clinician will discuss preparation needed prior to your injection date. This includes putting plans in place to rest after injection, arrange transport directly home after injection, and avoid arranging steroid injections close to holidays and vaccinations. 

Are there any risks or possible complications?

Your clinician will explain any potential side effects due to the injection.  These can include:

Very Common Risks (may affect more than 1 in 10 people):

• Bleeding – Although only a very small needle is used, localised soft tissue or joint bleeding and bruising can occur. This is usually only a concern if you are taking blood thinners.

• Bruising – This may last for up to 7 days but will settle over time.

• Discomfort around the needle insertion site.  This can happen in 12.5% of patients.¹  This is short lived and can be relieved with an ice pack or with simple painkillers.  Always follow the instructions provided in the leaflet supplied with tablets.

Common Risks (may affect between 1 in 10 and 1 in 100 people):

• Steroid flare.  A painful reaction around the injection site can occur within the first 24 hours and can last up to 5 to 7 days. This can occur in 2% of patients.²  This usually settles with time.

• Paler skin or loss of fat causing skin dimpling around the injection site.  This can occur in up to 4% of patients.¹  This may happen if the steroid leaks into the skin around the injection site or when you have a number of these injections at the same site.  This may be permanent.

• Feeling faint, fainting or nausea (feeling sick).  This can occur in up to 2% of patients.¹  It may help if you have a light meal 2 hours before your injection.

• Temporary flushing of the face or body (redness and heat).  This can occur in up to 5% of patients.²  This usually settles within a few days without any treatment.

Uncommon/Rare Risks (may affect between 1 in 100 up to 1 in 10,000 people):

• Infection (superficial, deep, limb/life threatening).  This can occur in 1 in 3,000 patients.³  Infection could be passed into your joint or soft tissue during the injection. The risk of infection is rare but can happen. You are at an increased risk if you have diabetes, rheumatoid arthritis or if you have had a recent infection. Steps are taken to prevent infection at the time of injection. The injection site is cleaned thoroughly and a sterile syringe and needle are used.  Your injection site will be covered with a dressing, which should be left in place for 24 to 48 hours. If the joint or soft tissue becomes very painful and hot, please contact the integrated musculoskeletal service on the telephone number at the end of this leaflet, your GP or 111 immediately.

• An allergic reaction or anaphylactic shock.  This can be life threatening. It is a rare, widespread reaction and generally happens in the first 30 minutes after the injection. 

Symptoms can range from mild, such as a rash, to more severe, such as swelling of the face and difficulty breathing.  

Severe reactions require immediate, emergency treatment. You must dial 999.

Risks where frequency is not known (cannot be established from the available data):

• Complex Regional Pain Syndrome. This is a very rare condition where pain develops after your injection and does not settle down.  Further treatment would be required.

• Damage to the blood supply of the soft tissue or bone surrounding the injection site can lead to death of tissue and/or bone. This can cause pain and the bone can become weaker and/or change shape.

• Raised blood sugar levels can occur for a few days after a steroid injection if you have diabetes.

• For women a temporary change to the menstrual cycle (Period).⁴   Some women may start their next period earlier than expected, or it may be delayed.  Some women may find their period is lighter or heavier than usual.

• If you have high blood pressure, your blood pressure may increase for a few days.  This can lead to symptoms of headache, nosebleeds, shortness of breath, visual problems, irregular heartbeat, dizziness or generally feeling unwell. Seek medical advice if symptoms occur.

• An injury to a nerve leading to numbness or pain. This is usually temporary but can be permanent.

• Changes to your mood and mental health or worsening of mental health conditions.

• Tendon and/or soft tissue rupture. The soft tissues can become weaker and tear around the injection site.  This is rare leading to deformity (for example a bent finger or toe) and may require surgical repair.

• Steroid may weaken your immune system increasing your infection risk.

Who can have steroid injections?

Most people can have steroid injections.

Tell your clinician before having treatment if you:

• Have had any changes to your health or medication so they can discuss suitability for steroid injection

• Have had a steroid injection in the last few weeks – you usually need to wait at least 6 weeks between injections

• You’ve had 3 steroid injections in the last few weeks – clinicians usually recommend no more than 3 injections in the same area in the space of 12 months

• Have had an allergic reaction to steroids in the past

• Have had infection ( including eye infections)

• Have recently had, or are about to have, any vaccinations

• Are pregnant, breastfeeding or trying for a baby

• Have any other conditions such as diabetes, epilepsy, high blood pressure, glaucoma, or problems with your liver, heart or kidneys

• Are taking other medicines such as anticoagulants (for example rivaroxaban, warfarin, apixaban, aspirin), steroid tables or antibiotics.

Steroid injections may not be suitable in all cases, although the clinician may recommend them if they think the benefits outweigh any risks.  In some cases, you may need further assessment or a temporary change to your usual medication prior to a steroid injection.  In some instances, a steroid injection may have to be done in a hospital setting.

What if I cannot attend my appointment?

If your appointment time is not convenient, it is essential you contact the Integrated Musculoskeletal Department immediately, so that a more appropriate time can be arranged. 

This will allow us to give the injection appointment to someone else.

What does the injection involve?

Before the injection the clinician doing the injection will answer any questions you have.  Your clinician will complete a checklist of questions to ensure it is suitable to proceed with the injection on that day. They will then ask you to sign a consent form to make sure you are happy to have the injection. It is your choice to have the injection and you always have the choice not to have the injection.

The steroid injection usually involves a single injection into one area. If there is more than one injection then this will be discussed with you. The area that is going to be injected will be marked and cleaned (sterilised) before the injection is given.  As with most injections you may feel a pin-prick sensation as the needle is inserted. There is often a sting as the drugs are administered but this is usually finished within a few minutes.  The injection site will be covered with a dressing which should be kept dry and left in place 24 to 48 hours after the injection.

What should I do after the injection?

Immediately after the injection you will be observed in the clinic room for about 5 minutes. Any follow up arrangements will be discussed with you.

We recommend that the injected area is rested as much as possible on the day of the injection and the day after. We also recommend that you restrict heavier activity and exercising for 2 weeks after the injection. Your clinician will be able to provide you with more specific advised depending on your job or hobbies. 

If you have any concerns before the injection, please contact the clinician who you saw in clinic who will be able to discuss the injection further with you. At any stage, you have the option of not having the treatment.

How long will it take?

You will be within the Department for 30 to 60 minutes.

Will the injection be painful?

You may have some discomfort during the injection. You may wish to take some painkillers later (always follow the instructions provided in the leaflet supplied with your tablets).

Can I drive home?

We advise that you DO NOT drive home immediately after an injection. You should arrange alternative transport. It is advised that you do not drive for 24 hours after your injection. You must be able to safely perform an emergency stop before you drive again.

Will I need further injections?

You will have a review appointment 6 weeks after your injection.  Your clinician will discuss if further injections are advisable at this time.

What are the alternatives to a steroid injection?

If you do not want to have steroid injection, or if you want to consider any alternatives, there are often other ways to manage musculoskeletal conditions.  Treatments such as exercise therapy, manual therapy and acupuncture can be useful and can be considered in conjunction with the physiotherapy service. Insoles can also be considered for foot and lower limb conditions. Consultation with your GP for further medication can also be considered in discussion with you.

What if there are any problems after the injection?

If you have any significant increase in pain, any redness or heat around the injection site, if you develop a high temperature (above 38 degrees), or feel very unwell you should contact the Integrated Musculoskeletal Department, your GP or 111 for advice. There are contact details below on this page.

If you have any general questions about the injection then please contact the clinician who did the injection. There are contact details below on this page.

Contact numbers

If you have any questions or concerns, please use the contact number below:

Integrates Musculoskeletal Department

North Tees and Hartlepool NHS Foundation Trust

Telephone: 01429 522471 (Option 1)

Opening hours: 9:00am to 4:30pm (Monday to Friday)

Further information is available from:

NHS Choices

Telephone: 111 (when it is less urgent than 999).

Calls to this number are free from landlines and mobile phones or via the website.

Versus Arthritis

Copeman House, St Mary’s Court

St Mary’s Gate, Chesterfield

S41 7TD

Telephone: 0300 790 0400

References

1. Brinks A, Koes B, Volkers A, Verhaar J and BiermaZeinstra S (2010) Adverse effects of extra-articular corticosteroid injections: a systematic review. BioMed Central Musculoskeletal Disorders, Volume 11, pages 1 – 11.
2. Kilmartin TE (2006). Critical Review: The Surgical Management of Hallux Valgus. British Journal of Podiatry, Vol 9, no. 1, pages 4 – 24.
3. Posmyk L, Kilmartin TE and Coutts A (2019) Rare but Real Post-Injection Infection. Podiatry Now, Volume 22, Issue 3, pages 8-13.
4. Versus Arthritis Leaflet: Steroid Injections, VA2250.

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