Steroid Injections - are they for you?
Steroid injections are a useful addition to more traditional physiotherapy modalities. They are used to help reduce inflammation in soft tissue such as the synovial lining of a joint or a tendon attachment such as a tennis elbow. Steroids are not aliens to the body. You make your own steroid to help with inflammation and tissue repair but not in a suitable quantity.
Steroid injections can be administered into an inflamed joint (intra-articular injection) or into inflamed tissue near to a joint like a ligament attachment or tendon sheath (peri-articular injection). The steroid injection will reduce inflammation, swelling and pain within the area and thereby help reduce the healing time.
The steroids we use are Hydrocortisone, Kenalog and Depo-medrone. We also use a local anaesthetic (Lidocaine or Bupivacaine) to produce a suitable numbing down of the area being injected.
The steroid is delivered in a slow release form. Once it has been injected it starts working almost immediately but it usually takes up to 48 hours before there is a significant improvement in your symptoms. The improvement usually continues for up to about 14 days though patients often report a further gain over the following 4/52.
The commonest injections we carry out are to and around the shoulder area. These include tendon injections to the rotator cuff, intra-articular injection for frozen shoulders and arthritic pain and to the shoulder bursa for impingement problems.
Tennis and golfers elbow are another group of conditions that respond well to peri-articular injections after a course of deep frictional massage and stretching.
De Quervains teno-synovitis of the thumb and trigger finger both respond well to local infiltration of the tendon sheath, as does the joint at the base of the thumb and the dorsal ganglions around the wrist.
The various bursa around the hip joints can often be settled down with a course of electrotherapy and selective soft tissue stretching along with an appropriately timed steroid injection.
We have also been having good results around the knee with joint and bursa aspiration followed by a suitably placed steroid injection.
Steroid injections are a useful adjunct to deep ultrasound and soft tissue stretching for plantar faciitis and chronic ligament strains around the ankle.
In the vast majority of cases one injection is all that is needed to relieve symptoms, however, a second and occasional a third injection is sometimes required.
There are far fewer side effects from the correct use of injected steroids as opposed to when using oral anti-inflammatory medication. Here at the clinic we are always very careful to select the lowest dose possible to produce a suitable improvement.
We liaise closely with your own doctor as to the suitability of injection therapy in the management of any musculo-skeletal disorder. If you have any concerns with having an injection as part of your treatment, Iain would be very happy to discuss these with you.
Some of the more common side effects include:-
Anaphylaxis is an allergic response to the injection. Although extremely rare it is potentially serious. Injections are only carried out at our York Bridge Site where we have a full medical team trained in its management and we carry the full range of anti-anaphylactic drugs.
Infection can complicate an injection procedure. Injections are carried out using a non- touch aseptic technique. The steroid injection may lower the auto-immune response locally allowing an infection already present in the body to attack the weakened area. For this reason we do not carry out injections on patients who are feeling unwell or just getting over an infection i.e. chest infection or urinary tract infection. For your safety we may choose to re-schedule a planned injection appointment.
There can be a slight increase in symptoms for first 24 hours. This is known as post injection flare.
Steroid injections can cause a temporary upset to the normal diabetic control and it is always a good idea to be vigilant of this if your diabetic control is unstable. There have also been cases of temporary increase of blood pressure.
Steroids can interfere slightly with the normal hormonal levels in the body. This can manifest in facial flushing often experienced the following morning. It is rare for this to last more than a few hours. Minor disturbances of the menstrual cycle in females are less common and will self-correct by the end of the next full cycle.
Steroid injections can cause slight alterations in the sub-cutaneous skin pigmentation and also atrophy in the subcutaneous fat layer. Very few injections are administered so close to the skin layer that this is likely to be a problem.
Remember that to date we have carried out over 1000 successful injections since 2003 with no complications.