Steroid Injections

Steroid also known as cortisone is a medication that is often misunderstood. The medication itself has multiple uses including the treatment of asthma, allergies, and the management of rashes and scars. In the context of treating musculoskeletal conditions such as bursitis and arthritis, it behaves as an anti-inflammatory agent that reduces swelling and secondarily helps to reduce pain. In its injectable form, a clinician can direct the steroid to the source of the problem thereby increasing the medication’s effectiveness and reducing the potential side effects. Typically, the steroid is mixed with a local anesthetic such as lidocaine to help distribute the injection fluid more evenly and provide some short-term analgesia. After the anesthetic wears off (in several hours), it’s not uncommon for the pain to increase back to pre-injection levels. It may take several days to a week for one to feel the full effects of the steroid. Once the steroid is actively working, it can provide months of pain relief for conditions like knee arthritis and shoulder bursitis. In certain situations, it may stop the inflammation and pain cycle long enough for a patient to rehabilitate the muscles that support the joint such that the symptoms do not recur.

The potential side effects of steroid injections include a steroid flare, which is a brief worsening of pain that typically lasts between 24 to 72 hours and self resolves. A small amount of the medication maybe absorbed systemically leading to a temporary flushing of the skin that can last a couple of days. In postmenopausal women, it may cause vaginal spotting, which should be assessed by a gynecologist. In diabetics, the medicine can increase blood sugars and if these levels are poorly controlled, the steroid injection maybe deferred until such time that the levels are better. The skin around a more superficial injection may lose some pigmentation that may or may not be permanent. There can also be some thinning or weakening of the tissue around which the steroid has been injected, which can lead to tendon tears or bone and cartilage damage such as AVN (avascular necrosis – the death of bone due to a lack of blood supply). To reduce this risk, there are standardized doses of the steroid used for common musculoskeletal conditions as well as the frequency that they can be repeated.

Whereas there isn’t a predefined limit to the number of injections you may receive for a particular condition, if symptoms continue to recur or the duration of relief reduces, your physician may recommend alternative management strategies. Finally, there is the risk of infection from a steroid injection and if you experience localized redness, swelling, pain or fevers/chills after an injection, it is important to contact your doctor.