About steroid joint injections
Steroid (also called corticosteroid) injections may be used for treating many different joints including the knee, shoulder, elbow, ankle, wrist and hip. They can be given by your GP, rheumatologist or orthopaedic surgeon. Joint injections may be done at your GP’s surgery, clinic or in a hospital.
Your pain relief can last for anything from one week to two months or longer, depending on the type of steroid that’s been injected. Some short-acting steroids act quickly (within hours) and may work for at least a week. Other, long-acting steroids may take about a week to start working, but their effects last for a few months. Sometimes a mixture of these may be used. Your doctor or another healthcare professional will discuss with you which is the best option in your circumstances.
The injections can be repeated every three months if you need them. General advice is that joints are injected no more than four times in one year.
Steroid joint injections don’t cure the underlying problem in your joint, but they may ease symptoms and allow you to cope with physiotherapy treatment better.
Preparing for a steroid joint injection
Your doctor or another healthcare professional will explain how to prepare for your procedure. You may also be given an information leaflet with details about steroid joint injections.
There aren’t usually any special preparations you need to make before a steroid a joint injection. Plan to wear comfortable clothing which allows easy access to the affected joint.
Check with your doctor or healthcare professional whether you’ll be able to drive after your joint injection. It might be best if you make arrangements beforehand for someone to drive you home. This is because you may have some numbness from the local anaesthetic in your injection which might make it difficult to drive. Also, be prepared to rest the affected joint for one to two days afterwards.
Your doctor or healthcare professional will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to ask questions so that you understand what will be happening. You don’t have to go ahead with the procedure if you decide you don’t want it. Once you understand the procedure and if you agree to have it, you’ll be asked to sign a consent form.
What are the alternatives to a steroid joint injection?
The alternatives to steroid joint injections will depend on what is causing your pain. Alternative treatments include steroid tablets, anti-inflammatory drugs, painkillers and physiotherapy. Speak to your doctor about the options available to you.
What happens during a steroid joint injection?
Your doctor will examine the area and thoroughly clean the skin over your affected joint with an antiseptic.
If you’re having a local anaesthetic, your doctor or healthcare professional may inject this into your skin first. They will then wait for three to five minutes for it to work. They’ll then use another needle to inject the steroid medicine. Or they may give the local anaesthetic as a combined injection with the steroid using a single syringe.
For certain joints your doctor or healthcare professional may use ultrasound during the procedure to help guide the injection into the right spot.
What to expect afterwards
If you have a local anaesthetic, the pain in your joint will ease within a few minutes. But the effects of the anaesthetic will generally wear off after an hour or two. You may need pain relief to help with any discomfort as the anaesthetic wears off.
You’ll usually be able to go home when you feel ready. It’s best to arrange for a friend or family member to drive you home because you may have numbness from your local anaesthetic.
Recovering from a steroid joint injection
You’ll feel some discomfort as the local anaesthetic wears off. For some people the pain may actually be worse than before the injection at first. This is due to inflammation caused by the injection itself – sometimes called a ‘steroid flare’. This may last for two to three days. If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.
If you have diabetes you may find that your blood sugar rises for a few days after your injection.
If you’re having physiotherapy, your physiotherapist may encourage you to move the joint. Alternatively, you may be advised to rest your joint for a day or two. Ask your doctor or healthcare professional whether you’ll need any time off work. It’s important to follow your doctor, nurse or physiotherapist’s advice.
Most people have no problems after steroid joint injections. Contact your GP if you get a high temperature, feel unwell, or if the pain doesn’t settle within the first couple of days.
What are the risks?
As with every procedure, there are some risks associated with steroid joint injections. We haven’t included the chance of these happening as they are specific to you and differ for every person. Ask your doctor or healthcare professional to explain how these risks may apply to you.
Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. Side-effects of steroid joint injections include:
- an increase in pain and swelling in the injected area – this usually settles within a few days
- a flushed or red face
- a rise in your blood sugar for a few days if you have diabetes
Complications are when problems occur during or after the procedure. Complications of steroid joint injections can include:
- infection – you may need treatment with antibiotics
- damage to the cartilage within your joint or tendons around it. This may be more likely with repeated injections
- thinning or a change in the colour of the skin around the injection site. This tends to be more common with stronger or repeated injections
- irregular periods in women, or vaginal bleeding even if you’re past the menopause
- changes in your mood
FAQ: Can my child have a steroid joint injection?
Steroids may interfere with growth and are rarely used for children. Steroid injections are sometimes used to relieve pain in certain conditions in under 18s, such as juvenile idiopathic arthritis.
Steroids can interfere with bone growth and therefore steroid joint injections are only rarely recommended for people under the age of 18. They may, however, be used in juvenile idiopathic arthritis, the most common type of arthritis seen in children. Young children or children having several injections may have the steroid injections under general anaesthesia or sedation.
If your child has joint pain or swelling, speak to your doctor about alternative treatments.
FAQ: Can steroid joint injections manage my symptoms over the long term?
Steroid joint injections aren’t usually used as a long term treatment.
Steroids joint injections are usually used to manage symptoms rather that treating the underlying cause of your condition. The aim of a steroid joint injection is to ease pain and swelling and reduce stiffness so that it’s easier to move your affected joint. Steroid joint injections are usually given along with other therapies to help treat or manage the condition causing these symptoms. For example, your doctor may also recommend anti-inflammatory medicines, rest, ice or heat and perhaps physiotherapy to help ease your joint.
Your doctor may suggest that you only have a limited number of injections in each affected joint, to reduce the chance of getting side effects. These include possible damage to your cartilage and tendons (see ‘Risks’ above for more details).
If you still have pain or swelling after a course of steroid injections, speak to your doctor about alternative treatments.
FAQ: How often can I have a steroid joint injection?
You should have a gap of at least three months between steroid injections in the same joint. And you should have no more than four injections a year into the same joint.
Some studies have suggested that repeated injections of steroids into your joints can damage the cartilage covering the ends of your bones. To reduce the chance of this, doctors try not to use these injections more often than every three months in the same joint. Also, no more than a maximum of four injections in a year are recommended.
If you still have pain or swelling after a course of steroid injections, speak to your doctor about alternative medical or surgical treatments.
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- Joint injection and aspiration. PatientPlus. www.patient.co.uk/patientplus.asp, published 16 May 2012
- Osteoarthritis. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published April 2015
- Osteoarthritis: Care and management in adults. National Institute for Health and Care Excellence (NICE), 2014. www.nice.org.uk
- Local corticosteroid injections. Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 25 May 2015 (online version)
- Local steroid injections. Arthritis Research UK. www.arthritisresearchuk.org, published September 2011
- Joint injection/aspiration. American College of Rheumatology. www.rheumatology.org, published February 2012
- Joint injection. InsideRadiology. The Royal Australian and New Zealand College of Radiologists. www.insideradiology.com.au, published 1 May 2009
- Arthritis in children. American College of Rheumatology. www.rheumatology.org, published 2013
- Juvenile idiopathic arthritis. BMJ Best Practice. www.bestpractice.bmj.com, published 28 January 2015
- Juvenile idiopathic arthritis (JIA). Arthritis Research UK. www.arthritisresearchuk.org, accessed 25 May 2015
- Sex-related side effects of corticosteroid injections. American Academy of Orthopedic Surgeons. www.aaos.org, published February 2015
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