Steroid Injection Therapy

 

Cortisone and Steroid Injections. 

 

What are Corticosteroids?

Cortisone is the name of a group of medicines that are very strong anti-inflammatories. Corticosteroids are naturally occurring hormones already present within the human body, they are very different to anabolic steroids as used by some bodybuilders. Cortisone can help reduce the pain of a tendon, joint or nerve that is inflamed.  The type of steroid and amount will depend on the structure and location we are injecting.

 

How are injections given?

The injections are delivered via a syringe and needle.  This needle is bevelled to ensure we can access the structure that is causing the pain.   We will use ultrasound to guide the needle into the joint so that we can target the tissue and ensure the injectate only affects the inflamed or painful body part.  We will typically give lidocaine (a local painkiller anaesthetic) with the steroid injection. 

 

What conditions are treated with cortisone?

Most painful tendons, joints and bursa can be treated effectively with cortisone injections. Inflammatory joint pain from osteoarthritis can be rapidly reduced with cortisone, as can nerve inflammation such as carpal tunnel syndrome.  Some of the common conditions include: 

  • Tendon Pain
  • Frozen Shoulder
  • Joint pain
  • Nerve Pain
  • Carpel Tunnel Syndrome
  • Tennis Elbow

 

Is cortisone a cure or a temporary fix?

  • Cortisone can be a cure for any pain that is entirely due to an inflamed structure such as frozen shoulder and tenosynovitis.
  • Cortisone can also be a temporary fix for any pain that is due to a minor injury, but the patient is unable to take the required time for the injury to heal itself. For example, with Golfer’s elbow in elite sports players who are required to continue with their sports activities.

 

How frequently can cortisone be given?

  • There are no lifetime limits on cortisone injections however expert medical consensus suggests there should be a 3-month gap between the administration of cortisone. Typically, if you do require more than 2 cortisone injections then you may be advised to consider other treatment options.
  • It is important to understand that cortisone is an excellent way to reduce pain quickly to engage in a rehabilitation programme, which will provide the long-term solution to most problems.

Will the injection hurt?

  • Minor discomfort is common and for most patients report the injection was far less painful than they thought.  We use ultrasound to guide injections which markedly reduces pain and trauma. 

Are there any complications?

  • Short term: A small number of people will experience a temporary increase in their pain as the cortisone is working. This is nothing to be concerned about and will pass after 24-48 hours.
  • Long Term: Too many cortisone injections can cause tendon damage or worsening osteoarthritis. If you are concerned about this, then your practitioner will be happy to discuss your specific case with you.
  • Many patients are concerned that steroid injections will make them gain weight. This is extremely unlikely after a corticosteroid injection as the doses are very small in comparison to oral steroids.
  • The rate and risk of infection is very very low.

 

What can I expect from the Injection?

The cortisone can be given with a local anaesthetic so you will usually experience a mild numbness and pain relief for a few hours. When the local anaesthetic wears off many people experience a dull ache or throbbing sensation. A small percentage of people will get a temporary increase in their pain; know as a ‘steroid flare’. This is nothing to be concerned about and painkillers such as paracetamol can be used to help calm symptoms, this will settle quickly.

  • It is often best to consider driving arrangements after an injection as the local anaesthetic can cause some localised numbness, therefore driving may be best avoided.
  • If you are having a joint injected then it is advised to avoid strenuous activity for at least 2 days. If an inflamed tendon is to be injected then 10-14 days of relative rest from sport activities is recommended.
  • Cortisone will actively work to reduce your inflammation for 21 days. This means that the benefits of cortisone are seen within 3 weeks. The vast majority of people will start to feel benefits within 7 days after the injection. 

 

Please call or email the clinic to speak to Adrian about Injection therapy and whether this is the right thing for you.