Local steroid injections can give rapid and effective reduction in pain and inflammation. However, improvements are usually temporary. As with all medicines, some people may experience side effects. The aim of this patient information is to provide you with the information that you need to know.
We ask all patients to provide written consent prior to booking an injection to ensure they have read and understood the information provided.
Steroid injections, also known as Cortisone injections, are anti-inflammatory medicines that are injected into a joint or soft tissue to help reduce localised inflammation and to reduce pain.
What happens after the injection?
If you have local anaesthetic, you may feel some pain relief within minutes, but this will normally wear off after a few hours. Steroids used for injections take up to two weeks to fully take effect, but the benefits can last for several months. We advise that pain relief ranges from several weeks to several months post injection. Unfortunately, no treatment will be effective for every patient and whilst most patients will experience at least partial benefit, a minority of patients may experience no relief.
You may wish to arrange alternative transport home after your injection, especially if you are having local anaesthetic which can cause some numbness and make it difficult to drive. Sometimes patients have pain after the injection so this should also be considered when planning your journey. You are welcome to also bring a friend or family member along to the appointment.
If you have any injection into the joint you should try to avoid strenuous exercise immediately afterwards, usually for two days.
If you are having an injection around a tendon, you may be asked to avoid heavy impact and loading activities for up to 2 weeks.
Will I need another injection?
If you find the injection helpful and other treatments are unsuitable or haven’t helped, the injection may be repeated. However, injections are most often used to provide a window of opportunity to engage in exercise and rehabilitation. Once your pain is better controlled, the need for injection should be reduced. Guidelines suggest limiting to a maximum of 3 steroid injections into the same area in a 12-month period.
Risks and side effects
Most people have steroid injections without any significant side effects. Listed below are the possible side effects.
Post-injection pain: Around a quarter (1 in 4) people may notice an increase in their pain (post injection flare) within the first 24-hours after injection. This usually settles within a couple of days. Simple painkillers, such as paracetamol and applying a cold compress, may help. Occasionally, post injection flare might be more pronounced and go on for up to a week. Very rarely, the pain can be severe (otherwise known as pseudo sepsis) and on these rare occasions, the patient must seek urgent medical attention.
Skin changes: Injections can occasionally cause some thinning and changes in the colour of the skin at the injection site (known as depigmentation). In rare cases a steroid injection into muscles or joints can cause an indentation in the skin around the area (known as fat atrophy).
Infection: Very rarely (approximately 1 in 50,000 people) a joint or soft tissue structure may become infected following an injection – signs of infection are increased pain, heat, redness and swelling. Patients will often feel generally unwell (e.g. fever and nausea). If you are concerned about possible infection you should seek medical attention immediately.
Risk of tendon rupture: mostly associated with steroid injections directly adjacent to weightbearing tendons – steroids may cause temporary weakening of tendons or ligaments at the injection site. Rupture is unlikely to occur if you take things easy for a few days after the injection.
Immunosuppression: Steroid injections may cause temporary immune suppression. This should be considered in relation to Covid-19. A two week interval should be left between receiving a Covid vaccine and having a steroid injection as the steroid may reduce the effectiveness of the vaccine.
Diabetes: Patients with diabetes may experience a temporary fluctuation in their blood sugar levels following a steroid injection.
Anaphylaxis: it is extremely rare to have an allergic reaction to steroid or local anaesthetic (1:500,000). This would usually happen within the first few minutes of an injection and requires immediate medical attention. Very rarely the allergic reaction can be delayed. The symptoms you might experience are feeling lightheaded or faint, breathing difficulties (such as fast, shallow breathing and/or wheezing), a fast heartbeat, clammy skin, confusion and anxiety, collapsing or losing consciousness. In this situation you must call 999.
Other possible side effects: dizziness, facial flushing, numbness around the area injected, blurred vision, vomiting.