• Reference Number: HEY039-2024
• Departments: Physiotherapy
• Last Updated: 1 March 2024

Introduction

This leaflet has been produced to give you general information about the benefits and risks associated with steroid injections for musculoskeletal conditions.  Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and your clinician, but may act as a starting point for discussion. If after reading this you have any concerns or require further explanations, please discuss this with a member of the health care team who has been caring for you.

What is a corticosteroid?

Corticosteroid is anti-inflammatory medicine that can relieve swelling, stiffness and pain.

Why do I need a corticosteroid injection?

It will help reduce your pain so that you can participate in physiotherapy or podiatry sooner, in most cases it can lead to a quicker return to normal activities.

Could I use anti-inflammatory pills or creams instead?

Yes, but because injections deliver the anti-inflammatory medication directly to the site where it is needed and therefore it works much more quickly. Pills and creams have to be absorbed through the stomach or skin and rely on the circulation to transport the medication to where it is needed. This means they are less effective. The use of anti-inflammatory pills may cause stomach problems in some people.

Are there any times when I should not have an injection?

You should not have an injection if you:

• Currently or recently have had an infection, on your skin or anywhere else in your body
• Are known to be allergic to local anaesthetics or steroids
• Feel generally unwell (including infection)
• Are due to have surgery in that area soon
• Are pregnant
• Are under 18 years of age
• Do not want the injection.

What are the possible side-effects?

• Flushing of the face for a few hours
• Small area of dimpling or a change in colour of the skin around the injection site
• Slight vaginal bleeding
• Diabetic patients may notice a temporary increase in blood sugar levels
• If you are taking blood thinning drugs, aspirin and warfarin there may be some temporary bruising
• Infection as a result of an injection is extremely rare; however, if the area becomes hot, swollen and painful for more than 24 hours you should contact your clinician or doctor immediately.
• Post injection pain is uncommon but it is possible that your symptoms may briefly worsen for a few hours after the injection. This does not affect the injection from working as normal.
• An allergic reaction to either local anaesthetic or steroid is an extremely rare side effect. You will be asked to wait 30 minutes after the injection to ensure there is no allergic reaction to the drug. Should a reaction occur, your clinician is trained and the clinic is equipped to manage this.

If you have any concerns please contact your clinician (Monday to Friday from 8.00 am to 4.00 pm) on telephone number 01482 674880. Outside of these hours you should seek advice from your GP or  the Accident and Emergency Department.

How is the injection given?

The skin is first cleaned thoroughly with an antiseptic wipe. The clinician will then insert a fine needle where there is access to the damaged tissues. In certain injections the solution will be injected all in one go, in other types of injection the solution will be spread around the problem area in a technique we call peppering. The type of injection you will have will be explained to you beforehand. A small dressing is then placed on the skin over the site of the injection.

Is the injection painful?

Any procedure using needles will have some associated discomfort; however, your clinician has had intensive training in the techniques used to maximise comfort throughout.

How fast does the injection work?

If local anaesthetic is also used, the pain from your tissue damage should reduce within a few minutes, though it may return after about an hour. Some injections are undertaken with steroid alone. The steroid usually starts to work within 24 to 48 hours but the steroid can continue to be absorbed for 3 to 4 weeks.

How long does the effect last?

This varies from person to person and the condition which is being treated, but the steroid usually continues working for 3 to 6 weeks.

How many injections can I have?

This depends on the part of the body involved and will be decided by your therapist and yourself.  Usually one injection is sufficient, but if the pain is severe or has been there for a long time, you may need more.

What should I do after the injection?

It is advisable to avoid any strenuous or repetitive activity which involves the part of your body where you received the injection for 1 to 2 weeks. You can continue the majority of your daily activities during this period. If you have any doubts then do not worry as this will be discussed in detail with you prior to the injection being given.

When will I have to be seen again?

Following the injection you will be referred back for further treatment. Once the injection has reduced the discomfort due to tissue damage, the clinician can address the underlying cause of the problem. They will then help you to improve the range of movement, flexibility and strength around the injured area, for a longer term solution to the problem.

How long does the injection work for?

This varies from person to person and for the condition that is being treated.

How many injections can I have?

This depends on the condition and the part of the body being injected. Usually one injection is sufficient. Repeat injections are required in some cases. If this is needed it will be discussed in detail with you by your clinician.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.