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Steroid Injections

Steroid injections are certainly the most commonly used joint injections for joint and tendon disorders. Steroid injections seek to rapidly reduce the inflammation and improve use of the joint. Following steroid injection, it is important to rest the joint for a few days, before gradually increasing activity and load bearing over the course of around one week. This is to reduce the risks of further tendon damage.

Risks of steroid injections include:

  • Pain: Although uncommon, some patients experience an increase in pain lasting from 2-5 days following the injection. Research has shown this to happen in up to 10% of patients. This can typically be managed with rest and cold compress.
  • Nerve injury & worsening of symptoms: This is typically only in the short term, but can lead to a sustained increase in symptoms. This is most commonly seen in carpal tunnel syndrome, although this risk remains less than 0.1%.
  • Infection: As with any surgical or medical intervention, there is an increased risk of infection. There is thought to be around a 005%- 0.0002% increased likelihood of septic arthritis. Signs of septic arthritis include a fever, increasingly swollen hot joint and increasing pain. If you find this you should speak to your GP or out of hours clinician for assessment without delay.
  • Atrophy (causing dimples) or hypopigmentation: This is at site of injection, and can come on in the days or weeks following injection. Although the frequency of occurrences following joint injections is unclear, this is thought to occur in around 0.5% of all cases, and usually spontaneously resolves within one year.
  • Tendon rupture: This is a rare but serious complication. It is to reduce the risks of this that I will advise rest for at least 5-7 days following the procedure, and gradual return to any heavy joint loading following injection.
  • Extra consideration with diabetic patients: Diabetics may notice a transient rise in their blood glucose in the days following injection and so may need to monitor their levels closely.
  • Extra consideration for those that monitor their blood pressure: Patients may notice a transient rise in their blood pressure in the days following injection.
  • Failure to work: This is always a possibility with any medical or surgical intervention. While we often see fantastic results, the pains may not resolve, or may return.
  • Risk of bleeding: Especially if on anticoagulants. Bleeding from the injection site would be stopped before leaving the clinic, but any further bleeding should be stopped with firm pressure for a minute or two and a simple plaster. Haemoarthrosis (bleeding into joint) is found in up to 0.15% of those on blood thinning medication, and lower in those not on blood thinning medications. People taking warfarin should ensure INR is below 3.0 prior to injection, if this level is agreed with primary healthcare provider.
  • Other potential complications: These include feeling flush or faint, allergic reaction, menstrual irregularity, vascular damage, and a small risk of temporary immunosuppression reducing the immune response against virus & bacteria.
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