Integrated Musculoskeletal (iMSK) Service Steroid Injections

This leaflet is designed to give you some information to help you prepare for your steroid injection and to give you some idea of what to expect during and after your injection. If you then have any questions you can ask the clinician who does the injection. 

What is a steroid injection?

Steroid injections, also called corticosteroid injections, are anti-inflammatory medicines used to treat a range of joint and soft tissue conditions. This includes osteoarthritis, frozen shoulder, bursitis, trigger finger, carpal tunnel syndrome, neuroma and plantar fasciitis.

How steroid injections work?

Steroids are a manmade version of hormones normally produced by the adrenal glands, two small glands found above the kidneys.

When injected into a joint or soft tissue, steroids reduce redness and swelling (inflammation).  This can help relieve pain which can make it easier to cope with your daily routine and reduce the need for painkillers for pain relief.

Steroid injections are different from the anabolic steroids used illegally by some people to increase their muscle mass. 

How long will it take to work?

The injections normally take a few days to start working, although some work in hours.  In the first 24 hours after injection you may feel your pain gets worse but it should improve over the next 2 to 3 days.

Will the injection hurt?

You may have some discomfort during the injection.

For some conditions, steroid injections may be mixed with a local anaesthetic and this can help to relieve discomfort immediately after your injection.  However, the local anaesthetic will start to wear off after a few hours. Your clinician can advise you on what injection is appropriate for your condition.

You may wish to take some painkillers later (always follow the instructions provided in the leaflet supplied with your tablets).

How long will it relieve my pain?

This can vary but can last from a few weeks to several months.  For some, there may be no relief from symptoms.

What preparation will I need?

Your clinician will discuss preparation needed prior to your injection date. This includes putting plans in place to rest after injection, arrange transport directly home after injection, and avoid arranging steroid injections close to holidays and vaccinations. 

Are there any risks or possible complications?

Your clinician will explain any potential side effects due to the injection.  These can include:

Immediate risks: during or shortly after the procedure

Common (more than 1 in 20):

• Pain / discomfort during or after the procedure: Some pain/discomfort may be felt during and after the procedure. Pain relief options are available and can be discussed before the procedure. It is also common to have some tenderness and/or bruising around the site where the injection was performed for a couple of days afterwards.
• Local anaesthetic pain: When a procedure is done using local anaesthetic, some tingling or stinging may be felt as the local anaesthetic is injected. This usually settles very quickly as the area becomes numb.

Rare (fewer than 1 in 100):

• Failure to complete procedure: Due to difficulties or complications it may not be possible to complete the procedure as planned.
• Allergic reaction or anaphylactic shock: This can be life threatening. It is a rare, widespread reaction and generally happens in the first 30 minutes after the injection. Symptoms can range from mild, such as a rash, to more severe, such as swelling of the face and difficulty breathing. Severe reactions require immediate emergency treatment. Seek urgent medical help by calling 999.
• Local anaesthetic systemic toxicity: Reactions can occur to local anaesthetic medications. A high level of local anaesthetic in the blood can lead to symptoms such as tingling (particularly around the mouth), dizziness, confusion and drowsiness. This can happen if local anaesthetic is inadvertently injected into the bloodstream.

Early risks: in the days after the procedure

Common (More than 1 in 20):

• Ongoing symptoms: Despite the procedure, symptoms may continue. Depending on the context this may lead to further tests or treatments being recommended. Following this procedure, it may take up to six weeks for pain symptoms to improve, and in some patients, it may not help with pain at all. It is also possible for the pain to flare up or be worsened following this procedure.
• An injury to a nerve leading to numbness: Numbness is the term for reduced touch sensation of the skin. It may also include reduced sensation of pain or temperature. It is often temporary, but can be permanent.

Less Common (fewer than 1 in 20):

• Injection site problem: This is a problem that happens where you had the injection. It may include bleeding, bruising, discomfort, redness, and infection.
• Side effects of injection steroids: Steroid medicines have a number of possible side effects. These depend on how much steroid is used over time (for example if repeated injections are needed). These include:
• Facial flushing: There can be a flushing of the face (redness and heat). This usually settles within a few days without any treatment.
• Steroid flare: This is a flare-up of pain around the injection site. This can occur within the first 24 hours and can last up to 5 to 7 days. It usually settles with time.
• Raised blood sugar levels can occur for a few days after a steroid injection if you have diabetes.
• For women a temporary change to the menstrual cycle (period): Some women may start their next period earlier than expected or it may be delayed. Some women may find that their period is lighter or heavier than usual.
• Paler skin or loss of fat causing skin dimpling around the injection site. This may happen if the steroid leaks into the skin around the injection site. The result may be permanent.
• The skin colour may change at the site of injection.
• If you have high blood pressure, this may increase for a few days. This can lead to symptoms of headache, nosebleeds, shortness of breath, visual problems, irregular heartbeats, dizziness or generally feeling unwell. Seek medical advice if symptoms occur.
• Feeling faint, fainting or nausea (feeling sick): This usually happens shortly after the injection. It may help to have a light meal 2 hours before your injection.
• Damage to the blood supply of the soft tissue or bone surrounding the injection site: This can lead to death of soft tissue and or bone. This can cause pain and the bone can become weaker or change shape.
• Steroids may weaken your immune system increasing your risk of infection.
• Mood changes: Some patients may experience a change to their mood or a deterioration of their mental health condition.

Rare (fewer than 1 in 100):

• Infection (superficial, deep, limb/life threatening): Infection could be passed into your joint or soft tissue during the injection. The risk of infection is rare but can happen. You are at an increased risk of infection if you have diabetes, rheumatoid arthritis, or if you have had a recent infection. Steps are taken to prevent infection at the time of the injection. The injection site is cleaned thoroughly and a sterile needle and syringe are used. Your injection site will be covered with a dressing, which should be left in place for 24 to 48 hours. If the joint or soft tissue becomes very painful and hot, please contact the Integrated Musculoskeletal Service on the telephone number provided, your GP or 111 immediately.
• Septic arthritis: Septic arthritis is the medical term used for an infection in the joint (the joint fluid or the tissues). It usually presents with joint pain and swelling. You may also feel unwell with symptoms such as a fever. Septic arthritis is serious and needs urgent treatment with antibiotics. Sometimes a procedure to clean out the joint (joint washout) is needed.
• Joint swelling or Haemarthrosis (blood in the joint).
• Tendon rupture: There is a small risk of damage to nearby tendons: the soft tissues can become weaker and tear around the injection site. This is rare and may lead to deformity (for example a bent finger or toe) and may require surgical repair. 
• Nerve Injury. There is a small risk of damage to nearby nerves. This may lead to numbness or pain. It is usually temporary but may be permanent.
• Deterioration in vision: Vision changes/eye damage: very rarely, steroid medications can cause damage to the eyes even when injected into a joint or around a nerve. It is important that you seek urgent medical advice if you experience any changes in vision.
• Complex regional pain syndrome: this is a very rare condition where pain develops after your injection and does not settle down. This could be permanent and further treatment would be required.

Late risks: In the months or years after the procedure

Common (more than 1 in 20)

• Recurrence of symptoms: Symptoms may come back having initially improved after the injection. Further treatment may be needed.

Less common (fewer than 1 in 20)

• Periarticular calcification: This is when small bits of calcium build up in the soft tissues around the joint that was injected, like muscles or tendons. This usually does not cause any problems but in some cases, it can make the joint stiff and sore.

Who can have steroid injections?

Most people can have steroid injections.

Tell your clinician before having treatment if you:

• Have had any changes to your health or medication so they can discuss suitability for steroid injection.

• Have had a steroid injection in the last few weeks. You usually need to wait at least 6 weeks between injections.

• You have had 3 steroid injections in the last few weeks. Clinicians usually recommend no more than 3 injections in the same area in the space of 12 months.

• Have had an allergic reaction to steroids in the past.

• Have had infection ( including eye infections).

• Have recently had, or are about to have, any vaccinations.

• Are pregnant, breastfeeding or trying for a baby.

• Have any other conditions such as diabetes, epilepsy, high blood pressure, glaucoma, or problems with your liver, heart or kidneys.

• Are taking other medicines such as anticoagulants (for example rivaroxaban, warfarin, apixaban, aspirin), steroid tables or antibiotics.

Steroid injections may not be suitable in all cases, although the clinician may recommend them if they think the benefits outweigh any risks.  In some cases, you may need further assessment or a temporary change to your usual medication prior to a steroid injection.  In some instances, a steroid injection may have to be done in a hospital setting.

What if I cannot attend my appointment?

If your appointment time is not convenient, it is essential you contact the Integrated Musculoskeletal Department immediately, so that a more appropriate time can be arranged. 

This will allow us to give the injection appointment to someone else.

What does the injection involve?

Before the injection the clinician doing the injection will answer any questions you have.  Your clinician will complete a checklist of questions to ensure it is suitable to proceed with the injection on that day. They will then ask you to sign a consent form to make sure you are happy to have the injection. It is your choice to have the injection and you always have the choice not to have the injection.

The steroid injection usually involves a single injection into one area. If there is more than one injection then this will be discussed with you. The area that is going to be injected will be marked and cleaned (sterilised) before the injection is given.  As with most injections you may feel a pinprick sensation as the needle is inserted. There is often a sting as the drugs are administered but this is usually finished within a few minutes.  The injection site will be covered with a dressing which should be kept dry and left in place 24 to 48 hours after the injection.

What should I do after the injection?

Immediately after the injection you will be observed in the clinic room for about 5 minutes. Any follow-up arrangements will be discussed with you.

We recommend that the injected area is rested as much as possible on the day of the injection and the day after. We also recommend that you restrict heavier activity and exercising for 2 weeks after the injection. Your clinician will be able to provide you with more specific advised depending on your job or hobbies. 

If you have any concerns before the injection, please contact the clinician who you saw in clinic who will be able to discuss the injection further with you. At any stage, you have the option of not having the treatment.

How long will it take?

You will be within the Department for 30 to 60 minutes.

Can I drive home?

We advise that you DO NOT drive home immediately after an injection. You should arrange alternative transport. It is advised that you do not drive for 24 hours after your injection. You must be able to safely perform an emergency stop before you drive again.

Will I need further injections?

Your clinician will discuss if further injections are advisable.

What are the alternatives to a steroid injection?

If you do not want to have steroid injection, or if you want to consider any alternatives, there are often other ways to manage musculoskeletal conditions.  Treatments such as exercise therapy, manual therapy and acupuncture can be useful and can be considered in conjunction with the physiotherapy service. Insoles can also be considered for foot and lower limb conditions. Consultation with your GP for further medication can also be considered in discussion with you.

What if there are any problems after the injection?

If you have any significant increase in pain, any redness or heat around the injection site, if you develop a high temperature (above 38 degrees), or feel very unwell you should contact the Integrated Musculoskeletal Department, your GP or 111 for advice. There are contact details below on this page.

If you have any general questions about the injection then please contact the clinician who did the injection. There are contact details below on this page.

Contact numbers

If you have any questions or concerns, please use the contact number below:

North Tees and Hartlepool NHS Foundation Trust

Integrated Musculoskeletal Service

Telephone: 01429 522471 (choose option 1)

Monday to Friday, 9:00am to 4:30pm

Email: [email protected]

If you have any worries or concerns, you should contact your GP during normal surgery hours. Outside surgery hours, you should contact your GP’s surgery for the Out of Hours Service number.

Further information is available from:

NHS website

Website: www.nhs.uk

Patient Experience Team

North Tees and Hartlepool NHS Foundation Trust would like your feedback. If you would like to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Team who will help you to do this.

This service is based at the University Hospital of North Tees but also covers the University Hospital of Hartlepool, our community hospitals and community health services.

North Tees and Hartlepool NHS Foundation Trust

Telephone: 01642 624719 / Freephone: 0800 092 0084

Email: [email protected]

Monday to Friday, 9:30 am to 4:00 pm

Out of hours if you wish to speak to a senior member of Trust staff, please contact the hospital switchboard (numbers below).

University Hospital of North Tees

Hardwick Road

Stockton-on-Tees

TS19 8PE

Telephone: 01642 617617

University Hospital of Hartlepool

Holdforth Road

Hartlepool

TS24 9AH

Telephone: 01642 617617