Steroids are commonly used to effectively reduce inflammation, pain and swelling. The aim is to deliver the medication directly to the site where it is needed. We also perform high volume injections for frozen shoulder and tendinopathy, and use Ostenil Plus injections for osteoarthritis. The injection is usually performed in combination with local anaesthetic.
The injection should help to
treat symptoms, and will also confirm any possible diagnosis and plan further
Ultrasound guided injections are more accurate and effective than those performed without image guidance.
There are some risks with an injection, and these are:
- A small amount of bleeding and bruising occurs in 1 in 100 patients, which will usually settle without any treatment.
- Numbness occurs in the region of symptoms, and may extend down a limb or into the hand/foot.
- There may be some pain, heat, redness and swelling for 1-2 days in the region of symptoms after an Ostenil Plus injection.
- Infection is very rare and occurs in less than 1 in 10,000 patients (see page 3).
- Allergic reactions to steroid, local anaesthetic
and Ostenil Plus are extremely rare, and should occur soon after
- Feeling faint or dizziness occurs in about 1 in 50 patients.
Risks particular to steroid injections include:
- Increased pain for 1-2 days after the injection. This is a steroid flare and not an infection, and usually settles with cool packs and regular painkillers.
- Irregular menstrual cycle for a few months.
- If you are a diabetic, particularly if you use
insulin, you may notice an increase in blood glucose levels for a few
- Facial flushing and/or a hot flush may occur for 1-2 days after the injection.
- The skin may go white and/or form a dimple around
the injection site due to fat loss. This
may take several months to resolve.
- Headaches (1 in 10 patients).
- Increased blood pressure.
- Tendons can be more prone to tears/rupture after steroid injections, and strenuous activity should be avoided for 3-4 months after the injection.
Potential Risks related to the COVID-19 virus
There is a potential risk that a steroid injection can weaken the immune system slightly, and therefore worsen symptoms of COVID-19. However, there have been no recorded cases of this actually happening, and this mostly relates to patients taking higher regular doses of steroids and SARS. Steroid injections have a much lower dose, and most of the steroid stays around the site of the injection. Interestingly dexamethasone (another steroid) has been found to be beneficial to reduce inflammation in the lungs in COVID-19 patients.
You may take any prescribed drugs
and medicines as usual (including blood thinning medication).
However, please tell the radiologist performing the injection if you:
· have an infection at the moment
· are diabetic (particularly if taking insulin)
· have any allergies, particularly involving: steroid, local anaesthetic, latex or cow’s milk
· are taking any blood thinning medication (anti-coagulants), for example: warfarin, aspirin, clopidogrel (Plavix), rivaroxaban.
· are taking bupropion (Zyban)
· are taking any anti-epileptic medication (including phenytoin)
· are taking any anti-retroviral or anti-viral drugs
· are taking any cardiac medications or beta-blockers
· are taking any medicines that can affect the immune system
· have had a recent vaccination, or are due a vaccination, both within 2 weeks of the appointment
· are taking any haloperidol or lithium
· are required to be at work in the next 2 days
· are likely to be involved in heavy physical activity at work in the next 4 days
· have had recent surgery, as steroid injections can affect healing
· have a peptic ulcer
· have had any side effects from steroids previously
Some gel will be applied to the area being examined and a smooth-surfaced ultrasound probe will be moved across this part of your body. The gel will enable good contact between the probe and your skin, as sound waves do not travel well by air. This procedure may be referred to as a ‘scan’.
The radiologist will determine the site of injection using the ultrasound machine. The skin will be cleaned with a sterile solution/wipe in the area of symptoms. A local anaesthetic may also be injected.
The radiologist will then position a fine needle accurately under ultrasound guidance. Once the needle is in position, the injection is given, which may involve steroid, local anaesthetic, normal saline, sterile water for injection, or Ostenil Plus.
The entire procedure usually takes between 10-20 minutes. The injection itself usually takes 10-30 seconds, or occasionally may take 1-2 minutes for high volume injections. After the scan, the gel will be wiped off your skin, and a plaster may be applied if needed. The plaster can be taken off at home.
You may have some numbness in the area of injection, if a local anaesthetic has been used. Injections in the groin/hip region can rarely cause numbness and reduced mobility in the leg for a few hours. Due to this, we advise you not to drive for six hours after an injection, particularly for injections in the hip and lower limb region.
If possible, do the minimum activities necessary for the next 2 days after the injection. During the first month post injection, you should not put any strain on the area of symptoms while the injection works.
If you have a local anaesthetic injected, you may not have any pain for the first few hours. When the local anaesthetic wears off, the area of injection may be painful for a few days afterwards. If this happens, applying an ice pack, and taking regular painkillers for 1-2 days can be helpful.
If you have had a tendon injection, you should avoid strenuous activities for at least 3-4 months afterwards. Physiotherapy follow up is important for advice on when and how to return to activities, and for advice on a rehabilitation/exercise programme. This is particularly important for tendon problems, as tendons can take 4-6 months to heal with the correct rehabilitation programme.
If you have severe pain, redness and swelling at the site of the injection, or fever persisting for at least 2-3 days after the injection, then this could be infection. You may need some antibiotics, so please see your GP urgently, or seek other urgent medical attention (i.e. at the Emergency Department).
If you feel drowsy soon after the injection, please report this to the radiologist at the time, or go the Emergency Department. This is extremely rare and could be related to the local anaesthetic injection. Other symptoms to look out for include confusion, dizziness, euphoria, tinnitus blurred or double vision, generalised sensations of heat, cold or numbness, twitching, and tremors.
Allergic reactions are also extremely rare, and can be treated at the time of injection. If they occur soon after the injection, look out for redness and swelling of the skin. Please seek urgent treatment from your GP or at the Emergency Department if this occurs once you have gone home, particularly if you are having difficulty breathing.
Most people notice an improvement within a few days or a week. However, it may take up to a month for the steroid to work. The benefit can last for 2-12 months, or for even longer sometimes. You may be given a post treatment diary to check your progress. This can be returned at your convenience.