We as physios often refer our patients who are in a great deal of pain, or not are not improving, on to the orthopaedic and sports physicians for a second option. If scanning reveals a tendinopathy, bursitis or inflamed region, a steroid injection is one of the tools available to help to settle this down. Corticosteroids are a class of medications that are related to cortisone, a steroid. Medications of this class powerfully reduce inflammation. These injections are beneficial at reducing pain, but are not however without their (rare) side effects, and need to be administered with the level of respect they deserve.
Corticosteroid injections given in the shoulder may reduce localised soft-tissue inflammation. Injections of cortisone and an anesthetic such as lidocaine are sometimes also used to confirm a diagnosis. Epidural injections in the lumbar spine (lumbar epidural) 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 there are administered
Often they are performed under ultrasound guidance to ensure the correct structure is targeted. Corticosteroid as well as a local anaesthetic (such as lidocaine) may simultaneously be drawn into the syringe. The needle of the syringe then is inserted into the tissue to be injected and the solution is injected. The needle then is withdrawn, and a sterile bandage is applied to the injection site.
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?
At times the relief from a cortisone injection begins almost immediately after the procedure, but it can take a week. A cortisone injection administered for certain conditions may be curative (such as for certain types of bursitis or mild trigger finger), but 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.