Steroid Injections

What is a steroid injection?

Steroid injections are commonly used for the treatment of joint and soft tissue disorders. Steroids have been shown to be helpful for easing pain and reducing high levels of inflammation. They may also protect the cartilage within joints.
Steroid injections are often used in conjunction with local anaesthetic. There are several different formulations of both steroid and anaesthetic which may be used.

Like all medication, an individual’s response to a steroid injection cannot be predicted. Most patients experience an improvement in their symptoms lasting a few weeks. For some the beneficial effect will persist for several months. Some patients unfortunately gain little or no benefit.

This information sheet is intended to supplement the advice you will be given by your doctor or physiotherapist with regard to the role of steroid injections in your particular circumstances.

Injections are not suitable for all patients.

Please inform the doctor or therapist if you believe any of the following may apply to you;

• Allergy to steroid or local anaesthetic
• Infection close to the site of the proposed injection or a significant infection elsewhere
• Broken skin or rash at the site of the proposed injection
• A tendency to bleed more readily as a result of illness or medication
• Surgical metalwork at the site of the proposed injection, for example a joint replacement, screws, plates, etc.

The risk of a complication arising from a steroid injection is low and serious complications are extremely rare. However occasionally the following may occur and may require medical attention;

• Some individuals are susceptible to fainting during medical procedures. Faints result from a sudden short term fall in blood pressure. Please inform the doctor or physiotherapist in advance if you feel this may be likely so that precautions can be taken.
• Some patients experience deterioration in their symptoms for about 48 hours after the injection. Rest and simple painkillers usually help.
• Infection may be introduced into the joint or soft tissues as a result of an injection. This is extremely rare but can have very serious consequences if not identified and treated promptly. If you experience progressive warmth, swelling or worsening symptoms at the injection site particularly in association with fever, seek urgent medical attention.
• Allergic reaction to the steroid or local anaesthetic. Any medication has the potential to precipitate an allergic reaction even in someone who has previously encountered the same medication without problem. This is most likely to occur within 20 minutes of the injection. You should therefore remain in the department for this time. Symptoms of severe allergy include; wheeze or difficulty breathing, swelling of the face, throat or tongue, rash or itching, stomach cramps and vomiting, or feeling very unwell. Call for immediate help if necessary.
• Bleeding or bruising. This is more likely if you are taking certain medications for example aspirin or warfarin, and usually settles with simple pressure. If you experience severe swelling or bruising after the injection seek urgent medical attention.
• Facial flushing (warmth and redness) may occur. This will usually resolve after 24-72 hours and predominantly affects women. It is not an allergy and does not preclude future injections.
• Thinning of the skin and soft tissues at the site of the injection may occur resulting in a dimple. Occasionally the formation of a small lump or loss of a small area of skin colour may also occur.
• Tendons may weaken when in contact with steroid resulting in rupture. This effect is thought to be very rare and may primarily affect damaged tendons already predisposed to rupture. Seek prompt medical attention if you experience new weakness in the affected body part.
• The steroid may occasionally cause irregular vaginal bleeding for a few weeks.
• Joint and soft tissue steroid injections can cause a rise in blood sugar for a few days in diabetic patients. The effect however is usually negligible and would not normally necessitate a change in treatment. In certain circumstances additional monitoring may be recommended.

After the injection

You will be asked to remain in the department or surgery for 20 minutes

Avoidance of strenuous activities is generally advised for a few days especially if steroid is injected in the vicinity of a tendon or into a weight bearing joint.

Additional advice and precautions relating to particular injections and procedures will be discussed if necessary at your appointment.

Is this the right treatment for me?

Other treatment options will be discussed with you before deciding to go ahead with the injections and your consent is needed. The decision on whether or not to go ahead with the injection(s) is a shared decision between you and your doctor. Your doctor will be able to provide you with up-to-date information about the likelihood of this being a successful treatment for you and how this treatment fits into the best pathway of care.

If you are undecided about whether or not to have injections then further advice and information to make this informed decision can be provided. Please speak to your doctor for more information.

If your health has changed, it is important to let your doctor know;

• If you have an infection in your body or on the skin of your back, your doctor will postpone the treatment until the infection is cleared
• If you have been started on anticoagulant or antiplatelet medicines that “thin the blood” such as warfarin, heparin or clopidogrel, this may require extra preparation
• If you suffer from diabetes, the use of steroids during injections may cause your blood sugar to change requiring monitoring and adjustment of your diabetic medication
• If you have any allergies
• You must also inform the doctor if there is any chance that you could be pregnant.
• Finally, if you are planning to fly or travel abroad within two weeks after the injections, please let your doctor know as it may be best to change the date of the injections.

I have heard that steroids are unlicensed, what does this mean?

Steroids have been used for a long time with only small risks. Around a quarter of medicines used in pain medicine are unlicensed - this means that the medicine has not been approved by a regulatory body for the purpose for which they are to be used. Therefore, these steroids cannot be marketed by the pharmaceutical industry. Medicines will only be licensed if there is a need for a pharmaceutical company to do this as the process of licensing is very expensive. Your doctor can discuss this with you further.

What follow-up will be arranged?

One Health will send you a confirmation letter through the post, confirming the details of your follow-up appointment. The follow-up is normally a face to face consultation in the clinic, but other times a telephone follow-up may be arranged.

Is there anything else I need to consider before the procedure?

• Please bring your glasses if you need them for reading
• Always bring a list of all current medication
• Continue to take your medication as usual on the treatment day