Table of Contents
What is an Ultrasound-guided injection?
A corticosteroid (or ‘cortisone’) is an anti-inflammatory medicine, which can be injected directly into the soft tissues or joints that are causing your symptoms. It is a safer alternative to taking anti- inflammatory medication by mouth. It acts directly in the area injected and is not the same as the steroids taken by bodybuilders or athletes.
Why should I have a corticosteroid injection?
The injection can help to relieve swelling, pain and stiffness caused by inflammation. This may in turn help you to start your rehabilitation and return to normal activities sooner by ‘breaking the cycle’ of pain and inflammation. It can also be helpful to aid in the diagnosis of your condition if it is not clear which structures are responsible for your pain. You may also have a local anaesthetic injected at the same time, which allows for temporary pain relief.
What are the risks?
Side effects of the injection are rare however include:
- Flushing of the face for a few hours.
- Infection: If the area becomes hot, swollen and painful for more than 24 hours, or if you feel generally unwell, you should contact your doctor immediately. If they are unavailable you should seek medical attention via your nearest hospital A&E.
- Post-injection pain: some patients may experience a ‘steroid flare effect’ the day after the injection. This is where the steroid temporarily makes the pain worse before taking it away. This usually only lasts 24 hours and is alleviated by simple pain killers. After this, the steroid should start to work over a few days and begin to improve symptoms. It can take up to a week before the full effects of the steroid is noticeable.
- Small area of fat loss or change in skin colour around the injection site.
- Diabetic patients may notice a temporary increase in blood sugar levels.
- Temporary bruising or bleeding if you are taking blood thinning medication such as aspirin or warfarin.
- Slight vaginal bleeding / menstrual irregularities.
- Allergic reaction (anaphylactic shock): This is an extremely rare side effect but is a medical emergency and is associated with difficulty breathing amongst other symptoms. It is most likely to happen in the first 15 minutes following an injection but can happen up to 6 hours after the procedure. For this reason you will need to remain in the clinic for 20 minutes after your injection. If you have any difficulty in breathing or any usually symptoms you MUST tell us immediately. If it happens after you have left you must seek medical help immediately by calling 999.
- Steroids may possibly reduce the strength of your immune system for a few days during which time you may be at an increased risk of injections such as Covid-19. However, the procedure involves an very small dose of steroid which is injected directly into a joint or tendon. This makes it highly unlikely to affect the rest of your body. Furthermore, if you have received a Covid-19 vaccine, this will further minimise potential risks.
Are there any contraindications?
You should not have the injection if you:
- Have an infection in the area or anywhere else in your body
- Are allergic to local anaesthetic or steroid medications.
- Feel unwell
- Due to have surgery in the treatment area soon.
- Are pregnant or breast-feeding.
- Have poorly controlled diabetes.
- Do not want the injection or have a needle phobia.
Are there any alternatives?
- Lifestyle changes – rest activity modification
- Heat or cold packs
- Pain relieving anti-inflammatory gel
- Anti-inflammatory medications
What happens during the injection?
- The benefits and risks of the injection will be explained to you
- You will be placed in a position that is both suitable for the injection and comfortable for you.
- The skin is cleaned with antiseptic
- A needle is gently positioned into the affected area and solution injected through the needle.
- A plaster or dressing will be placed over the site to keep it clean.
What happens after the injection?
- It is not advisable to drive for 24 hours after the injection given the effects of the local anaesthetic, therefore arrangements to get home should be made prior to the appointment.
- If local anaesthetic is used in the injection your pain may start to improve within a few minutes although this may return when it wears off (similar to when you visit the dentist).
- The steroid usually starts to work after 24-48 hours, but it can take longer.
- The effect of the injection varies from person to person and usually continues to last for about 6 weeks.
- This does not necessarily mean that you will need a second injection, so long as you follow the advice given to you after your injection.
What do I need to do after I go home?
- Depending on the cause of your pain, you may be asked to rest the area for a short period of time following the injection.
- Following a shoulder, arm or hand injection, avoid lifting, pushing, pulling anything more than a light weight for 2 weeks.
- Following an injection in the leg, avoid running, excessive stair climbing, pushing heavy weights with your legs for 2 weeks.
- Refrain from activities that make your pain worse or contact activities for at least 2 weeks.
- If you are having other medical treatment within 6 weeks, you should inform the treating clinician that you have received a corticosteroid injection.
Will I have a follow up appointment?
A follow up appointment is not necessary after an injection, however should you wish you may request one (fees apply).
What if my injection does not work?
Research evidence supports the injection and most people feel the procedure helps, however it does not work for everyone. Sometimes a course of injections are required. For safety reasons however there is an upper limit to the number of injections a person should have in any given area and time and not everyone will benefit. Should the injection not provide you benefit, you should seek alternative ways to manage your symptoms.