A GP or specialist may refer you for a steroid injection, but what is it?
A steroid, or cortisone/corticosteroid, injection contains a strong anti-inflammatory medication that may help to settle pain that is not changing with physiotherapy management or that is hindering you from completing an exercise program or functioning with daily life. A cortisone injection may be administered for certain conditions to relieve pain, such as for bursitis, mild trigger finger or low back pain, but injections of cortisone and an anaesthetic such as lidocaine can sometimes be used to confirm a diagnosis.
For example, corticosteroid injections given in the shoulder may reduce localised soft-tissue inflammation or bursal inflammation. Epidural injections in the lumbar spine are cortisone injections inserted into a specific location in the spinal canal of the low back by a specialist under X-ray guidance. These injections may help relieve back pain and sciatica. Epidural injections can also be given in other areas of the spinal canal to relieve upper back and neck pain.
How are they administered?
Corticosteroid injections are commonly delivered by a specialist under a guided ultrasound to ensure the correct structure is targeted. Corticosteroid, as well as a local anaesthetic (such as lidocaine), may simultaneously be drawn into a syringe, which is then inserted into the tissue where the solution is injected. The needle is withdrawn and a sterile bandage is applied to the injection site. At times the relief from a cortisone injection begins almost immediately after the procedure, but it can take up to 14 days for someone to notice a change in symptoms.
Short-term complications are uncommon but include:
- Shrinkage (atrophy) of the subcutaneous fat/ tissues
- Lightening of the of the skin at the injection site
- Local infection
- Local bleeding
- Soreness at the injection site
- Aggravation of inflammation in the area injected because of reactions to the corticosteroid medication (post-injection flare)
- Tendons can be weakened by corticosteroid injections administered in or near tendons. Tendon ruptures as a result of steroid injection have been reported
Long-term complications of corticosteroid injections depend on the dose and frequency of the injections.
With higher doses and frequent administration, potential/rare side effects include:
- Thinning of the skin
- Thinning of the cartilage
- Ligament weakening
- Tendon rupture
- Arthritis due to crystallisation of the steroid
- Elevation of blood pressure
- Cataract formation
- Thinning of the bones (osteoporosis)
- Avascular necrosis or osteonecrosis (very rare)
How Long Does A Cortisone Injection Work For?
A steroid injection can be used to help reduce inflammation in the short term, but for longer term benefit physiotherapy and active management strategies are most important. With some conditions, the symptoms of the condition recur after a few weeks or months. In this situation, another cortisone injection can be given, but risks of side effects increase with more frequent or regular injections.
To find out whether we can help you with your pain or dysfunction, before or after a steroid injection, contact us now!