A corticosteroid injection into a joint is a frequently preformed procedure. It is usually done to reduce inflammation and pain. A joint injection can give a pain free window in which to enjoy a holiday or special event, and an opportunity to work on pain free exercises for long term resolution of the problem.
The Uses of a Corticosteroid Joint Injection
Steroid injection can be given into soft tissues, or into joints. Injections into a joint are known as intra-articular injections.
A corticosteroid intra- articular injection is given to suppress inflammation and therefore decrease pain. A corticosteroid joint injection is usually given with a local anesthetic.
A corticosteroid joint injection can be useful in situations such as:
- a flare up of knee arthritis
- impingement at the shoulder which is causing pain
- tennis elbow
Possible Side Effects of a Steroid Joint Injection
Corticosteroid joint injections, when done by a trained practitioner, are generally very safe, however like all medication there are some potential side effects which must be considered before deciding to go ahead with an injection. These side effects include:
- Pain. Some people find the injection itself painful. The injection is often given with some local anesthetic, once the anesthetic has worn off there may be some post injection pain, which usually lasts no more than 48 hours. The steroid can take 3 - 5 days to take effect.
- Bleeding and bruising - clearly the injection involves introducing a needle through the skin, sometimes this may cause bleeding, and if bleeding does occur bruising may follow.
- Infection - this is one of the more serious of the potential side effects. The occurrence of infection after injection is infrequent, but injecting a joint does provide a potential route into the joint for bugs and if infection does occur this can be very serious. A good medical practitioner will do everything possible to reduce any risk of infection including washing their hands first, using sterile single use needles and cleaning the skin before introducing the injection
- Facial flushing- The face can become red and flushed, this can occur in up to 5% of people after a steroid injection and when it does occur it lasts from 24 - 48 hours (Saunders 2002)
- Allergic reaction - along with joint infection allergic reaction, or anaphylactic shock, is the most serious of potential side effects following a joint injection. It occurs when the person is allergic to any compound of the drug that is injected. This can be a life threatening medical emergency and all good practitioners who do injections will have appropriate skills and equipment to recognise and treat any occurrence.
- Control of insulin in people who are diabetic. Steroid affects insulin control. Usually the amount of steroid put into a joint is small, and is absorbed from the joint into the system so slowly that diabetic control isn't affected. However diabetics who have a steroid injection should monitor their blood sugar levels more closely for 48 hours after the injection.
- Subcutaneous atrophy/ skin depigmentation This is more of a problem when the injection is into soft tissue, like a tennis elbow, rather than a joint, but it can occur in some of the joints which are close to the surface, like the thumb joint. The skin in the surrounding area can loose some of its pigment, meaning it looses colour, this is more noticeable on people who have a darker skin colour. Additionally the fat around the injection site can be reabsorbed which is known as subcutaneous atrophy.
Who Can't Have a Corticosteroid Injection?
Generally steroid injections are very safe, but there are certain occasions that they should not be used:
- Artificial Joint - If the joint has previously been replaced and there is an artificial joint in place then the risk of infection is higher and it is generally considered unwise to introduce an injection into the joint. The exception to this is when the surgeon who replaced the joint feels that the injection is justified.
- Previous allergic reaction to the medication. If someone has had a previous allergic reaction to any of the medications to be used, then that injection should be avoided for fear of an anaphylactic reaction.
- Infection in the joint - any joint which is suspected to have an infection in it should not be injected
- Immediately after injury- A corticosteroid injection should not be used in the very early stages after an injury because it could induce further bleeding and worsen the injury
- Systemic Infection- a corticosteroid joint injection should not be done when the person is suffering from a generalised infection as this increases the risk of the joint becoming infected.
There are certain situations where a corticosteroid joint injection can be given, but does carry some increased risk and therefore the benefit expected from the injection should be weighed up against the risk.
- Pregnancy or Breast Feeding
- Diabetes- corticosteroid can affect the insulin control. Diabetics should keep a check on their blood sugars for 48 hours after an injection.
- If a joint replacement is planned Many orthopedic surgeons do not like there to have been an injection in the months before a joint replacement is done, this is because the risk of infection in the replacement may be increased.
- Immunosuppressed- If the immune system isn't working effectively, such as during a course of chemotherapy, of is there are other diseases such as AIDS, the risk of infection to the joint increases.
- Bleeding Disorder/ Taking Drugs to Thin the Blood bleeding and bruising is more likely after the injection.
- Injection into a weight bearing tendon: many practitioners do not inject steroid into or around weight bearing tendons such as the achilles tendon as there is an increased risk of the tendon becoming weakened and rupturing later
Will a Steroid Joint Injection Cure the Problem?
In conditions where inflammation is the prime cause of the pain a corticosteroid injection may entirely abolish the problem. In long standing conditions where there are underlying changes, such as for instance in arthritis, a corticosteroid injection does not provide a cure. The purpose of using an injection in such circumstances is to provide temporary pain relief; this may be useful to enable someone to have better enjoyment of an occasion such as a holiday, or a family wedding. The period of pain relief can also be used to provide a window to do exercise to strengthen muscles and mobilise the joint and thus decrease ongoing problems.
As with all things in medicine the relief from pain following steroid injection is variable from person to person. Unfortunately some people don't get any benefit, whereas others will get many months of relief.
Disclaimer: The information on this page is written to help you understand more about corticosteroid injection. A qualified health professional such as a Chartered Physiotherapist or your GP is the best person with whom to discuss the personal appropriateness of an injection.
