Corticosteroid Injections

A corticosteroid (or ‘cortisone’) is an anti-inflammatory medicine, which can be used to treat a variety of musculoskeletal conditions. They can be injected directly into the tissues that are causing your symptoms. In CMATS we generally do injections into joints, bursae and tendon sheaths. It acts directly in the area injected and is not the same as the steroids taken by bodybuilders or athletes.

Effects of injections

The injection can help to relieve swelling, pain and stiffness caused by inflammation. This may in turn help you to start your rehabilitation and return to normal activities sooner by ‘breaking the cycle’ of pain and inflammation. It can also be helpful to aid in the diagnosis of your condition if it is not clear what is responsible for your pain.

The injections can take a few weeks to start working, some start working within a few hours.

The effects of injection may wear off in a few months, but, if combined with the right rehabilitation there can be longer lasting effects in some conditions.

Possible side effects of injections

The possible side effects of the injection are rare and can include:

Flushing of the face for a few hours.
Small area of fat loss or change in skin colour around the injection site.
Paler skin around the injection site – this can be permanent

A temporary increase in pain 24 to 48 hours after the injection.
Patients with diabetes may notice a temporary increase in blood sugar levels. If you have diabetes, you are advised to check your blood sugar levels for three days post-injection.
If you have high blood pressure, your blood pressure may be raised temporarily.
Temporary bruising or bleeding in the injected area, especially if you are taking antiplatelet medicines (such as aspirin) or anticoagulant medicines (such as warfarin). Please advise the team if you are taking any blood thinning medicines.
Infection: If the area becomes hot, swollen and painful for more than 24 hours, or if you feel generally unwell, you should contact your physiotherapist or doctor immediately. If they are unavailable, you should seek advice from your GP or Emergency Department (A&E).

Slight vaginal bleeding/menstrual irregularities.
Allergic reaction to the drug: This will usually happen immediately so you will be asked to wait for a short time after your injection to check for any reactions.

Who can have a steroid injection?

Most people can have corticosteroid injections, although we may need to take certain precautions in some situations, for example, if you are on anticoagulant medication ( blood thinners), have diabetes or high blood pressure.

You should not have the injection carried out if you:

have an infection in the area to be injected or anywhere else in your body
are allergic to local anaesthetic or steroids
feel unwell
are due to have surgery in that area soon
are pregnant or breastfeeding
have poorly controlled diabetes
do not want the injection.

COVID-19 and joint and soft tissue steroid injections
We are still learning about this new disease and the way it affects patients who are given some of our drugs. At the moment there is limited evidence available on the use of steroid injections during the coronavirus pandemic.

There is a theoretical risk of a steroid injection making a patient more susceptible to contracting Covid19; having it for longer; and experiencing increased complications. Theoretical means that this could be possible but hasn’t been scientifically proven. Because of this our injection clinics are not running at present and when we restart we may have extra precautions in place.

Further information with regards to Covid-19 and corticosteroids can be found on the versus arthritis website. Please follow this link https://www.versusarthritis.org/covid-19-updates/covid-19-advice-for-people-taking-steroids/

If you would like further information on corticosteroid injections, then please follow the links below :-

https://www.nhs.uk/medicines/hydrocortisone-injections/

https://www.versusarthritis.org/about-arthritis/treatments/drugs/steroid-injections/