If a corticosteroid injection has been recommended it is important you consider the benefits and risks of this in order for to decide if this is right for you. The following information is to help you with this decision but if you have any questions or concerns at all please contact us or speak directly to the clinician at your next appointment.
There are a few circumstances where corticosteroid injections might not be recommended or further discussion is required. Please let the clinician know if you have previous allergic response to medicines, think you might be pregnant, you are diabetic, you are taking blood-thinners, steroid tablets or if you had a corticosteroid injection within the previous 6 weeks. You should avoid corticosteroid injections for 2 weeks before or after a Covid-19 vaccination (this does not apply for flu vaccinations), if you have recently had chemotherapy or if you are taking antibiotics, anti-retroviral medicines or taking medication for epilepsy. Let us know if you are needle-phobic or prone to fainting.
Corticosteroid injections are non-essential treatments to assist with pain and function and support other therapy. Injections for musculoskeletal conditions are generally safe but are not entirely without risk. Complications are rare and mostly not serious.
Serious complications are very rare and include allergic reactions (anaphylaxis) and infection. Both can have serious, life-changing consequences and are likely to require hospital treatment. Some joints (e.g. end of the collar bone, hip) have a slightly more vulnerable blood supply. It’s not clear that steroid injections definitely endanger this but there is some weak evidence that it may. This could theoretically lead to a rapid weakening and deterioration of the joint called Avascular Necrosis.
Less serious but important side effects may occur depending on individual circumstances, location and type of injection:
- Skin discolouration and skin thinning at the site of injection (superficial injections eg wrist)
- Nerve / vascular injury and temporary numbness from local anaesthetic
- Tendon rupture and accelerated joint degeneration with repeated injections
- Bleeding into a joint or muscle, particularly important if you are on blood thinners
- Blood sugars rise, particularly important if you are diabetic
- Hormonal-type symptoms such as facial flushing, mood swings and menstrual irregularity
- ‘Steroid flare’ – pain worsens initially typically 24- 48hrs
- Immune suppression: With injections (compared to a course of tablets) most immune effects will be local to the area injected but studies show there is a wider response with slight increased risk of infection. This occurs primarily within the 2 -4 days following injection with effect diminishing over the following fortnight
Immediately after the injection you should wait in the clinic for at least 15 minutes and let us know if you feel unwell. It’s a good idea to then have an easy day and avoid strenuous exercise for a week. During this period please check for signs of infection: redness, heat and increased pain the injected area, you might also feel unwell and have a raised temperature. If this happens please contact us, your GP or call 111. Please avoid using anti-inflammatory tablets for two weeks after corticosteroid injection as there is an increased risk of stomach upset / bleed.
Frequently Asked Questions:
Is cortisone the same as steroid?
Cortisol is a steroid hormone that’s released into your blood stream from the adrenal glands when you’re stressed. In large quantities it can suppress your immune system and inflammatory response. Synthesised cortisone is a powerful, longer lasting form of cortisol.
Which conditions can cortisone injections treat?
Cortisone injections can be used to improve pain and inflammation caused by arthritis, sports injuries and soft tissue injuries. It is sometimes used as a diagnostic tool, to help identify the source of your symptoms.
Should I stop my anticoagulant (blood thinner) before the injection?
Cortisone injections (other than into the spine) are a low risk procedure for bleeding. However if you are taking a regular blood thinner you should speak to a clinician regarding the relative risks of stopping your blood thinning tablets for 48hrs or longer before your appointment. Aspirin is not usually a concern but other antiplatelet therapies like Clopidogrel and blood thinners such as Apixaban and Rivaroxaban should be discussed before injection. Warfarin treatment may have additional risks and it would be helpful to have a recent (within 2 weeks) INR test. It may not be advisable to have an injection if the INR is above 3
How long will it take?
A cortisone injection is a very quick procedure that usually lasts a few seconds but can take a little while to set up and administer safely.
Will it hurt? Will I need an anaesthetic?
Most tolerate the discomfort of an injection very easily. We can use a local anaesthetic to minimise any discomfort during and immediately after treatment.
Can I drive myself home?
For most injections, people feel fine afterwards and can operate their vehicle normally. But response to treatment can vary and it is not certain how insurance companies would respond if you were unlucky enough to have an accident immediately after an injection. So if you prefer to be cautious you should have someone else drive you home. If you are happy to accept a small degree of risk then you can drive provided you do not have any adverse effect from the injection and you feel perfectly safe to operate your vehicle. You should not drive yourself home after a nerve block.
When will I see an improvement?
Your symptoms should start to ease after a few days and continue to improve over the next week. The effects of the injection can last for many months – it varies person to person.
Why bother with a treatment that is only temporary?
For certain conditions injection is the primary treatment and can be the most effective way of managing the problem. Injection may result in good quality and long term relief. Other conditions can be more resistant to treatment but there are still potential benefits. Good short term response helps clinicians confirm diagnosis and may help predict response to other treatments such as surgery. Medium term response allows you to engage with activity, exercise and there may be longer term benefits from this.
How often can I have a cortisone injection?
You should wait at least six weeks between cortisone injections. Although injection can reduce inflammation it can have a negative effect on tendon and joint strength so highly repeated injections are not desirable. But in some cases, repeat injections may be recommended, for example when surgery isn’t an option. You should not use repeated injections as a short-term solution when longer term gains can be made from exercise, weight loss and other therapies