What is a steroid injection?
Steroid injections are used to ease swelling, stiffness and pain by reducing inflammation. The injection maybe into a painful joint but may also be used to treat inflammation in soft tissues, such as tendons, tennis elbow or plantar fasciitis.
Why do I need an ultrasound guided injection?
The purpose of the steroid injection is to reduce the inflammation and therefore the pain in the affected area. This will enable you to use and exercise the body part more normally and aid your recovery. Ultrasound guidance may be used when an injection without guidance is technically difficult or did not provide the expected benefit.
Are there any times I should not have an injection?
Yes, If you:
- Have any infection on your skin or anywhere else in your body
- Are allergic to local anaesthetic or steroid
- Feel unwell
- Are due to have surgery at the area soon
- Do not want the injection
The procedure will be explained to you and you will have the opportunity to ask any questions you may have. If your symptoms have changed since you were referred or the clinician feels that the injection may be unsuitable for you, they will discuss this with you and inform the referring clinician.
Important things to know
The purpose of the injection is to reduce pain and/or inflammation in the affected joint or tendon injected.
Rare complications include:
- There is a small risk of infection (approximately 1 in 10,000 procedures) following injections. If you experience symptoms such as expected pain, warmth or redness around the are injected or generalised symptoms like chills, rigor, unexplained fever or flu like symptoms you should immediately consult your own GP or attend A&E and explain you have recently had an injection, as an infection could potentially be serious.
- Bleeding into the joint (usually only a concern in patients on warfarin or similar blood-thinning drugs)
- Allergic reactions to the local anaesthetic used in the injection.
- Female patients may notice their menstrual cycle is slightly irregular for a few months following steroid injection.
- When a tendon or ligament area of the lower limb has been injected, there have been some case reports of tendon tearing (rupture) following local steroid injections. This is rare and most likely occurs when the pain relief from the injection encourages overuse of an already frail tendon. The ultrasound before the injection will allow some assessment of the health of the tendon to advise whether an injection should not take place.
Occasional adverse effects include:
- There is a risk of facial flushing following steroid injection.
- There may be minor bruising at the site of the injection.
- The injected area may feel sore for about 48 hours after the injection.
- For superficial injection like in the hands and feet, there is a small risk of depigmentation (lightening of the
skin) and a skin dimple due to steroid induced lipoatrophy (loss of fat tissue).
- People suffering with diabetes may find their blood sugar control is likely to deteriorate for a few weeks.
- Side effects such as those seen with regular steroid treatment (e.g. weight gain, osteoporosis) are rare with local steroid injections unless they are given frequently.
Side effects are kept to a minimum by careful technique, examination and keeping drug dose to recommended levels. Every effort is made to prevent infection by hand washing, cleaning of the area and use of sterile equipment.
About the procedure itself
The clinician will identify the site for injection by moving an ultrasound probe over the area, with you either lying on a couch or sitting on a chair. Your skin will then be cleaned with a sterile solution. Local anaesthetic may be injected at the same time as the steroid, which will provide short-term relief. There may be more than one injection depending on the area being treated.
The whole procedure should last between 15 to 30 minutes.
After the procedure
If local anaesthetic has been injected you may not feel any pain for a few hours afterwards. The area may feel uncomfortable and once the anaesthetic wears off you may feel increased pain for a few days afterwards.
Depending on the type of injection you may not be able to drive for between 4 to 6 hours afterwards. You may therefore need to arrange someone to drive you home afterwards (as your insurance may not cover you).
How fast does the injection work?
The steroid usually starts to work within 24-48 hours but may take longer. It is also advised that you rest the affected joint(s) as much as possible over the following 24 – 48 hours before gently returning to normal activity. Resting the joint(s) may help to achieve maximum benefit from the injection.
When an area next to a tendon or ligament of the lower limb has been injected, it is advised to avoid impact exercise for a period of 2-4 weeks.
Will the injection help?
There is good 90% chance injections will help to settle down pain and inflammation. However, we cannot guarantee that ultrasound guided injection will improve symptoms, in that instance further tests or a different method of treatment may than be necessary.
How long does the injection work?
This varies from person to person and the condition being treated, but the steroid usually continues working for 4-6 months.
How many injections can I have?
Usually one injection is sufficient, but if the pain is severe or has been there for a long time, you may need more. However, you cannot have any more than 3 steroid injections per part of the body in a year.