What is a corticosteroid injection?
A corticosteroid (or ‘cortisone’) is an anti-inflammatory medicine, which can be injected directly into the tissues that are causing your symptoms. It is a safer alternative to taking anti-inflammatory medication by mouth. It acts directly in the area injected and is not the same as the steroids taken by bodybuilders or athletes.
What are the benefits –why should you have a corticosteroid injection?
The injection can help to relieve swelling, pain and stiffness caused by inflammation. This may in turn help you to start your rehabilitation and return to normal activities sooner by ‘breaking the cycle’ of pain and inflammation. It can also be helpful to aid in the diagnosis of your condition if it is not clear what is responsible for your pain. You may also have a local anaesthetic injected at the same time, which gives temporary pain relief.
What are the risks?
The possible side effects of the injection are rare and include:
- flushing of the face for a few hours.
- small area of fat loss or change in skin colour around the injection site.
- a temporary increase in pain 24-48 hours after the injection. If you experience increased pain for a longer period of time then please contact us for advice.
- patients with diabetes may notice a temporary increase in blood sugar levels. If you have diabetes, you are advised to check your blood sugar levels for three days post-injection.
- temporary bruising or bleeding in the injected area, especially if you are taking antiplatelet medicines (such as aspirin) or anticoagulant medicines (such as warfarin). Please advise the team if you are taking any blood-thinning medicines.
- infection: If the area becomes hot, swollen and painful for more than 24 hours, or if you feel generally unwell, you should contact your physiotherapist or doctor immediately. If they are unavailable, you should seek advice from your GP or Emergency Department (A&E).
- slight vaginal bleeding/menstrual irregularities.
- allergic reaction to the drug: This will usually happen immediately so you will be asked to wait for a short time after your injection to check for any reactions. If you have any signs of an allergic reaction after you have left the hospital then please seek medical advice.
- patients with HIV can have side effects if taking certain medications.Before injection we will ensure that this is the most appropriate treatment.
You should not have the injection carried out if you:
- have any infection in the area to be injected or anywhere else in your body
- are allergic to local anaesthetic or steroids
- feel unwell
- are due to have surgery in that area soon
- are pregnant or breastfeeding
- have poorly controlled diabetes
- do not want the injection.
What happens during the injection?
The benefits and risks of the injection will be explained to you in detail. You will then be placed in a comfortable position. The skin is cleaned with antiseptic. A needle is gently positioned into the affected area and the solution is injected through the needle. A plaster will be placed over the site to keep it clean. A few minutes after the injection you will be examined again.
Will you feel any pain?
The injection is not particularly painful as the doctor is thoroughly trained in this procedure. Sometimes it can be sore for a few hours after the procedure. It is safe for you to continue to take prescribed analgesia during this period.
What happens after the procedure?
If a local anaesthetic is also used in the injection, your pain may start to improve within a few minutes; although this may return when it wears off (similar to when you visit the dentist). The steroid usually starts to work after 24-48 hours, but it may take a little longer. The effect of the injection varies from person to person and usually continues to last for about 6 weeks. This does not necessarily mean that you will need a second injection, as long as you follow the advice given to you after the injection.
Driving home after the injection
We advise against driving yourself immediately after the injection due to the local anaesthetic, which can affect the sensation temporarily.
What you need to do after you go home
Depending on the cause of your pain, you may be asked to rest the area for a short period after the injection. This does not usually mean total rest but refraining from activities that make your pain worse, after which you should try to gradually return to full function. This is to maximize the benefit given by the injection. You may also be shown some exercises to do while you are in the clinic, or referred for physiotherapy treatment. If you are having other medical treatment within six weeks, you should tell the treating clinician that you have received a corticosteroid injection.
Will you have a follow-up appointment?
You may be asked to attend a follow-up appointment a few weeks after your injection to check your progress. Sometimes, more than one injection is needed and this can be discussed at this appointment.
Coronavirus vaccine and steroid injections
The coronavirus vaccine consists of 2 doses, that can be given 3-4months apart. There is a theoretical risk that steroids might reduce the immune response that is stimulated by vaccines, which means the amount of protection might be reduced. We advise you not to have a steroid injection on the same day as a dose of the coronavirus vaccine, and you should avoid having a steroid injection for at least 2 weeks after a dose of the vaccine. If you are planning on having the vaccine, we advise you not to delay being vaccinated while you are waiting for the steroid injection. When you are booking an appointment, please tell the staff if you are planning to have, or have already had, the vaccine. We will schedule the steroid injection to accommodate your vaccine date if necessary.
Acknowledgement: This patient information has been prepared using Leaflet number: 2574/VER7 of Guy’s and St Thomas’ NHS Foundation Trust