Local steroid injections offer swift and effective relief from pain and inflammation. However, it’s essential to note that these benefits are typically temporary. Like all medications, some individuals may experience side effects. The purpose of this patient information leaflet is to provide you with comprehensive information. We kindly request written consent from all patients before any injection to ensure they have read and understood this information.

Understanding Steroids and their use

Some steroids occur naturally in the human body, while others are synthesized to mimic the natural ones, reducing inflammation. Steroids can be administered orally or through injections. They find applications in various medical fields to treat inflammatory conditions.

Steroids are often recommended for individuals experiencing musculoskeletal pain, such as inflammatory arthritis or osteoarthritis, as well as a range of other soft tissue conditions involving pain and inflammation.

Steroids used in injections may take up to 2 weeks to reach full effect, and pain relief can extend from several weeks to several months post-injection.

It’s crucial to understand that not all patients will respond the same way, with some experiencing no relief.

When should steroid injections not be used?

Injections are not suitable for all patients. Please inform your clinician if you believe any of the following may apply to you:

  • Allergy to steroid or local anaesthetic
  • Infection close to the site of the proposed injection or a significant infection elsewhere
  • Broken skin or rash at the site of the proposed injection
  • A tendency to bleed more readily as a result of illness or medication
  • Surgical metalwork at the site of the proposed injection, for example a joint replacement, screws, plates etc.

The Injection Process

  • A clinical assessment and the use of an ultrasound scan help pinpoint the source of pain and deliver the injection more accurately.
  • The clinician performing your injection will select the most suitable steroid and dosage for your condition.
  • The injection is typically administered directly into the inflamed area, such as a joint or soft tissue.
  • Our clinic has strict infection control measures in place, which will be followed throughout the injection process. Most injections are quick and straightforward.

After the Injection

  • If you receive a local aesthetic, you may experience immediate pain relief, but this effect usually subsides within a few hours. The steroid’s full effect may take several days, and in some cases, up to 2-3 weeks, to manifest.
  • It’s advisable to arrange alternate transportation, especially if you receive a local aesthetic that can cause numbness and make driving challenging. Some patients might experience post-injection pain, so plan your journey accordingly. You are welcome to bring a friend or family member along to your appointment.
  • After a joint injection, it’s recommended to avoid strenuous exercise for up to two days. This advice may vary depending on your specific injury, so discuss it with your treating clinician.
  • If the injection is around a tendon, you may be asked to avoid heavy impact and loading activities for up to two weeks, depending on your injury and circumstances.
  • While a doctor’s referral is not mandatory for an injection, we provide a report after the procedure that we suggest forwarding to your GP for your medical records.
  • The injection site should be kept clean and dry for 24 hours post-injection.

Need for Future Injections

If you find the injection beneficial, and other treatments are ineffective, it may be repeated. However, injections are often used as a means to facilitate exercise and rehabilitation. Once your pain is better managed, the need for injections should decrease. Current guidelines recommend limiting the number of steroid injections in the same area to a maximum of three within a 12-month period.

Risks and Side Effects:

Most people tolerate steroid injections well without significant side effects. The risk of side effects may be slightly higher with stronger, longer-acting steroids like Triamcinolone acetonide and Methylprednisolone, which provide extended treatment effects. For safety reasons, if you have unstable blood pressure or uncontrolled blood sugar levels due to diabetes, your clinician may delay your injection until you obtain consent from your GP.

  • Steroid injections may temporarily suppress the immune system, which is a factor to consider in relation to Covid-19. A two-week interval is recommended between receiving a COVID vaccine and having a steroid injection to ensure vaccine effectiveness.
  • Pain and Discomfort: While there can be some discomfort during the injection, many individuals find it less uncomfortable than expected. This discomfort is usually brief and quickly resolves.
  • Potential Increase in Pain: Approximately one in four people may experience increased pain (post-injection flare) within the first 24 hours following the injection. This typically subsides within a few days and can be managed with pain relievers like paracetamol and cold compresses. In rare cases, post-injection flare can be more pronounced and last up to a week.
  • Very rarely, severe pain (known as pseudo-sepsis) can occur, and in such instances, immediate medical attention is necessary.
  • Osteonecrosis: The risk of osteonecrosis is highest with prolonged, high doses of exogenous steroids, particularly in the presence of other risk factors. Short courses of steroids however have also been shown to increase the risk of this very rare complication.
  • Skin Changes: Occasionally, injections may cause thinning and changes in skin color at the injection site (depigmentation). In rare cases, injections into muscles or joints can result in skin indentation (fat atrophy).
  • Infection: Infections following an injection are exceedingly rare. If the treated joint or soft tissue becomes more painful, hot, red, and swollen, along with general symptoms like fever and nausea, seek immediate medical attention.
  • Weight Gain: Concerns about weight gain following a steroid injection are unwarranted. Injected steroids can be administered in low doses, minimizing the risk of systemic side effects.
  • Diabetes: Patients with diabetes may experience fluctuations in blood sugar levels after a steroid injection. Type 1 or insulin-dependent diabetics and those with unstable blood sugar levels HbA1c above 8.5% (70mmol/l) should consult their GP before booking an injection.
  • Other Possible Side Effects: facial flushing, temporary menstruation and mood changes, dizziness, and changes in vision or visual acuity.

Taking Other Medications

You can take other medications alongside local steroid injections. However, for specific conditions like diabetes, cancer, or HIV, it’s advisable to consult your GP or treating consultant to ensure the injection’s safety.

Pregnancy and Breastfeeding

Steroid injections are not offered to pregnant patients. If you are breastfeeding, please ask your therapist for guidance using a leaflet from the Breast Feeding Network in 2014.

Summary of Risks and Side Effects

    • Serious side effects are rare and may include joint and soft tissue infections (approx. 1 in 50,000) and anaphylaxis (extremely rare, but requires immediate medical attention)
    • Other potential side effects include the risk of tendon rupture (mostly associated with weightbearing tendons), temporary immunosuppression (considering Covid-19), local subcutaneous fat atrophy, local depigmentation, post-injection flare of pain (usually mild, but occasionally more severe), destabilization of blood sugar levels in diabetics, blurring of vision, and other very rare complications.

 You will be observed for 20 minutes after the injection to monitor any possible adverse reactions.

If you have questions or require further information, please call 01635 767 003 or email info@geckofitness.com, and we will arrange for one of our clinical specialists to speak with you.

Cost of Steroid Injections

Cost per injection: £270 (Reviewed September 2023)

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