Corticosteroid injections

Corticosteroids (also known as steroids) are medicines that can be used to treat inflammation. When corticosteroids are injected into or around a painful area (such as a joint or muscle) they can reduce the inflammation in that area, relieving pain, reducing tissue swelling, and improving function and mobility. Depending on the condition that is being treated, steroid injections can provide pain relief for several weeks to up to many months.

Corticosteroids mimic natural hormones produced by the body — specifically by the adrenal glands, which sit atop the kidneys. Corticosteroids should not be confused with male and female steroid hormones, which are sometimes misused by athletes and body builders.

Which conditions can corticosteroid injections treat?

Corticosteroid injections can be used to treat a variety of conditions, including the following.

Arthritis

Steroid injections can effectively treat the joint inflammation that is seen in people with rheumatoid arthritis. They can also be used to relieve the pain of osteoarthritis (the most common form of arthritis) and gout.

Tendinitis

Tendons are the thick bands of tissue that connect muscles to bones. Repeated motion and stress to a tendon can cause it to become inflamed — this is known as tendinitis. Rotator cuff injury of the shoulder and tennis elbow are 2 common examples of tendinitis that can be treated with corticosteroid injections.

Bursitis

Bursas are small, fluid-filled pads that allow tendons and muscles to slide easily over bones. The pain associated with inflammation of a bursa (bursitis) — a condition which usually affects the shoulders, elbows, hips and knees — can be treated with steroid injections.

Trigger points

A trigger point is a hard, knot-like area in a muscle that results from repetitive stress on the muscle. Trigger points, which are most often found in the neck, back, shoulders and hips, are painful to touch and can refer pain to other areas of the body when pressed. Injections of different medicines, including corticosteroids, can be used to treat the pain associated with trigger points.

Carpal tunnel syndrome

Compression of the median nerve (which supplies sensation to your thumb and most of the first 3 fingers) within the narrow passageway in your wrist known as the carpal tunnel causes pain, numbness and tingling in the wrist and hand. By reducing inflammation in the carpal tunnel and relieving pressure on the median nerve, corticosteroid injections can ease the pain of carpal tunnel syndrome.

When are corticosteroid injections used?

Although steroid injections can often effectively relieve the pain associated with musculoskeletal conditions, they are usually not used as the initial treatment option. Less invasive treatments, such as rest, oral pain relievers, hot and cold compresses and physiotherapy, are usually tried first.

Is the injection painful?

Cortisone injections can usually be performed in your doctor’s office. The injection itself can be uncomfortable, so your doctor may give you a local anaesthetic to numb the skin before the injection.

A local anaesthetic medicine such as lignocaine is also usually added to the corticosteroid injection. This anaesthetic can relieve your pain immediately, confirming the injection has hit the right spot. After a few hours, the anaesthetic will wear off, and you may feel some pain or discomfort until the anti-inflammatory effect of the steroid kicks in, which is usually after a couple of days. Putting ice on the area and taking a pain medicine (such as paracetamol) may help relieve any discomfort in the meantime.

Do I need to restrict my activities after the injection?

After you have had a corticosteroid injection, you need to rest the affected area for 24 hours, and avoid strenuous activity for several days.

Risks and side effects

One of the most common side effects is pain and inflammation of the tissues surrounding the injection site. This is known as post-injection flare, or steroid flare, and may last for a couple of days.

People with dark-coloured skin occasionally report skin discolouration around the injection site.

There is also a risk of nerve damage associated with steroid injections.

There is a small risk of infection associated with these injections. Joint infections are especially serious, and can result in permanent damage to the joint. See your doctor as soon as possible if:

  • you experience pain for more than 48 hours after the injection;
  • pain develops more than 2 days after the injection;
  • the area becomes red, hot or swollen; or
  • you develop a fever following the injection.

Corticosteroid injections may weaken tendons, sometimes causing tendons to rupture. Repeated injections of steroids may also damage joint cartilage and contribute to thinning of nearby bone (local osteoporosis). For these reasons, there are limits to how many times and how frequently corticosteroid injections can be used in the same area.

Long-term problems associated with corticosteroid medicines

People who take steroid medicines orally for prolonged periods are at risk of several side effects, including weight gain, high blood pressure and osteoporosis. There is only a very small risk of these problems developing following injections of corticosteroid, because, unlike when a person takes steroid tablets, only very small amounts of the medicine enter the bloodstream.

Last Reviewed: 20 December 2012
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References

1. Corticosteroids: use in rheumatology (revised October 2010). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2013 Mar. http://online.tg.org.au/complete/ (accessed May 2013).
2. MayoClinic.com. Prednisone and other corticosteroids (updated 1 Dec 2012). http://www.mayoclinic.com/health/steroids/HQ01431 (accessed May 2013).
3. MayoClinic.com. Cortisone shots (updated 16 Nov 2010). http://www.mayoclinic.com/health/cortisone-shots/MY00268 (accessed May 2013).
4. Arthritis Australia; Australian Rheumatology Association. Patient information on prednisolone and prednisone (revised Sep 2010). http://www.rheumatology.org.au/community/documents/Prednisolone_2012updateFL.pdf (accessed May 2013).
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