Steroid injections
What is a Steroid (Cortisone) injection
Cortisone is a corticosteroid and potent anti-inflammatory agent released by the adrenal gland in response to stress. Artificial preparations such as Triamcinolone are injected directly into an affected joint to relieve pain and reduce inflammation.
The benefits from these medications often last several weeks or months, and in some conditions settles the problem completely.
For patients unable to have Orthopaedic surgery due to underlying health conditions, steroid injections can significantly improve their quality of life and reduce the burden of taking strong painkilling medications every day.
Side effects
Not common but certain injection sites can be more prone to particular side effects than others.
- Steroid Flare – Occasionally the cortisone crystallizes in a joint and causes pain. Studies found this can occur when injecting a frozen shoulder more than other joints and can last up to 4 days. If you develop a steroid flare, I recommend resting from aggravating activities, including sports, until the pain settles. Applying ice packs and taking regular anti-inflammatories (if not contraindicated) will also help. Any redness or pain lasting more than a few days should be discussed with a Healthcare Professional.
- Bleeding at injection site – Can occur if taking blood thinning medications such as Apixaban, Rivaroxaban or, Warfarin. Please speak to the Doctor prior to injection if taking these medications to help manage this risk. The medication may need to be adjusted depending on the injection site.
- Elevated blood sugars for patients with Diabetes who monitor their levels.
- Facial flushing – caused by the steroid medication. More common in females and and can last for 3-4 days.
- Infection – Injections are performed using aseptic techniques but infection can occur in approx. 1:10,000 patients. In such cases, the pain in the affected joint would be so severe that you would be unable to move the limb, your temperature may be elevated and you would feel sick and unwell. It is important that such symptoms be discussed with a healthcare professional as soon as possible.
- Irregular menstruation or occasional spotting may occur for a few weeks in pre-menopausal patients. Any post-menopausal bleeding requires discussion with your GP.
- Immunosuppression – it has been suggested that steroid injections can reduce the efficacy of live vaccines if given within a 2 week window of the vaccine administration. Please also advise the Doctor if you are taking any immunosuppressive medications such as chemotherapy.
- Skin discolouration – with certain injections close to the skin surface the steroid can cause a patchy discolouration of the skin which is unfortunately a permanent change.
Is a steroid injection painful?
Contrary to popular belief, the majority of steroid injections are not painful and most people tolerate these injections very well. At PortPrivate we endevour to make an injection as painfree as possible however, some when injecting areas such as Plantar Fasciitis some discomfort is unavoidable.
How long does it take for a cortisone injection to work?
Generally, a cortisone shot takes 1-2 days to start working and up to 2 weeks to have maximal effect. This fact can be important to know when you have an upcoming event, such as a waking holiday, family gathering, golf match or a sports final. Choosing the right time time for an injection can make a significant difference to the quality of your family time and performance.
If possible it is best to leave about 2 weeks before such an event for the injection to fully work and any side effects to settle. Resting a shoulder for 48hrs after the injection can reduce a steroid flare from occurring or worsening.
How long does a steroid injection last?
The effect of a steroid injection can last anywhere from 6 weeks to 6 months. Steroids do not not change the underlying degenerative process such as Osteoarthritis but this window of pain relief can significantly help with rehab or strengthening.
This window of pain relief can reduce a patients reliance on strong painkillers on a daily basis which themselves often have side effects. Combining a cortisone injection with exercise and lifestyle changes often provides the greatest level of longterm relief. The Doctor will discuss these factors at the time of injection.
How many steroid injections can you have?
The general rule is 3 injections per 12 month period into a weight bearing joint (knee, ankle), This reduces to 2 per 12 months if a patient has Osteoporosis or Osteopenia. Generally, if the first injection doesn’t help, we may inject the same area again after 6-8 weeks. However, if a second injection doesn’t help, we don’t recommend a third injection. For some patients it may be possible to have 2 separate steroid injections into different parts of your body at the same time.
Can you get a steroid injection after a knee or shoulder replacement?
Injecting an artificial joint increases the risk of infection and should not be performed in any joint replacement.