Corticosteroid Injection Pre-Treatment Information (MSK) - Dynamic Regenerative Medicine
You are receiving this information because you are interested in having treatment injection treatment of corticosteroid for your musculoskeletal complaint. Moreover, your condition has been identified as one that may benefit with this form of treatment. Here, we provide some basic information instructions regarding this injection procedure.
Cortisone (steroid) injections are commonly used for treating many musculoskel pain conditions, most commonly including joint arthritis, chronic tendinitis and bursitis. Cortisone injections are anti-inflammatory injections that often help by reducing inflammation and pain.
corticosteroid injection is considered a safe treatment with side effects tending to be mild. However, there are a few things that should be considered before having a cortisone injection.
Cortisone Injections for Pain Relief
Cortisone is a anti-inflammatory treatment used to treat pain and inflammation. Cortisone injections usually work within a few days, and the effects can last up to a couple of months. Often cortisone is mixed with local anaesthetic to provide both immediate pain relief and for diagnostic purposes.
What Can Cortisone Injections Treat?
Cortisone injections can be used to treat many musculoskeletal conditions where inflammation is present. Some of these conditions include:
Joint arthritis
Shoulder tendinitis
Joint bursitis
Frozen shoulder
Tennis/golfers elbow
And many more...
What are the Side-Effects of Cortisone Injections?
Like any drug, side-effects or reactions are always a possibility.
Systemic Side Effects
Systemic side effects of a local injection of cortisone are usually mild and minor, unlike taking oral steroids. These may involve:
1 Elevated Blood Sugar
The most common systemic reaction is seen in diabetic patients. Patients with diabetes should carefully monitor their blood sugar following a cortisone injection. If the blood sugar rises more than anticipated, you should contact the providers who manages your diabetes to see if additional treatment is necessary.
2 Facial Flushing
Patients may experience flushing sensation and redness of their face.
Local Side Effects
1 Post injection flare
Although not very common, some patients have discomfort after the injection and may experience a post-injection flare 24 to 48 hours after.
2 Infection
Although fortunately rare, with any injection procedure there is always a chance of infection. To maximise avoidance of this, the area of skin will be sterilised prior to treatment.
3 Skin Pigmentation Changes
Patients with darker skin should also be aware that cortisone may cause the skin around the injection site to lighten, however, this is often present in superfecial injections.
4 Fat Tissue Loss
Increased levels of cortisone can have detrimental effects on soft tissues in the body. When injected local to fat tissue, cortisone can lead to fat loss, which can lead to dimpling of the skin or thinning.
5 Tendon Rupture
Although a good anti-inflammatory, cortisone can cause tissue damage and weakening of tendons. This is why are you are limited to a certain amount of injections. This is also another reason why it is advised that you are not injected into a tendon as it can lead to tendon rupture. This is another reason why it is advised that cortisone should not be injected into a loading tendon, example Achilles tendon, patella tendon…
6 Cartilage Degradation
Reports have identified that cortisone injections can be damaging for cartilage long-term. Studies have shown that cartilage degradation has been identified with repeated steroid injections causing further degenerative changes.
Other rare side effects include hiccups.
Indeed, in the literature, side-effects or complications of cortisone injections are very uncommon. The main risk may include local infection, however, this is rare. We generally tend to see a little bit of mild post-treatment soreness (85% of cases) which is generally short-lived and well tolerated. Of course this to be expected with any injection procedure and generally settles after a couple of hours to a day or so. In 15% of cases, if you get a small reaction, it can be a little bit stiff and sore for a few days. It is possible, but very uncommon that you get a severe reaction. But if so, it can be associated with pain, discomfort and stiffness for a couple of weeks. However, this is seldom seen (less than 5%). Continued post treatment pain can always happen, but is very rare. But if this happens, it may warrant further investigation and maybe surgical opinion.
Worst case side-effects are obviously, infection, nerve/vessel damage, tendon damage/rupture, severe reaction. However, very strict protocols are adopted to minimalise this risk with the best sterile care. Fortunately, we can say that in all of our years of practice we have zero reported cases.
Infections: fortunately are rare, but if do happen in any case, need to be dealt with very promptly. Signs of infection are hot, very swollen, very stiff and general feeling of unwell. If this is to be expected, it is advised to head to A&E to get treated immediately with antibiotics.
Overall, cortisone injections are considered safe, but risks and side-effects can be present with any drug related procedure and should be acknowledged. Many clinicians will offer an injection as they are quick, easy, and most often effective. However, you should also be offered other treatments to combat pain and inflammation as many treatments can also be effective, like platelet rich plasma (PRP) treatment or hyaluronic acid treatment, which again can treat many forms of pain or injury. Platelet rich plasma therapy is also know as ortho-biological treatment and is complete natural, which the potential for tissue regeneration.
Treatment Plan
There is no particular number of injections that can be given, but often, clinicians do not want to give more than 3 due to the risk of soft tissue damage. Unfortunately, steroid injections can be short lived. If an injection wears off quickly or does not help the problem, then repeating it may not be worthwhile. Repeated cortisone injections multiply these effects and increase the risk of potential problems.
We like to explain to our patients that cortisone injection works in 3's - 1) works well, up to a period of two years, where are you can work on strengthening and rehabilitation, 2) work, short term, and then the problem returns, and 3) minimal positive benefits. In the majority of cases, we see a benefit of up to 6 months that can be prolonged with the correct rehabilitation. Please acknowledge the fact that in chronic degenerative conditions like osteoarthritis, cortisone injections are not a long-term solution.
Contraindications to corticosteroid injections include:
1. Allergy or hypersensitivity to corticosteroids or any of its components.
2. Active infection in or around the injection site or a systemic infection.
3. Pre-existing joint instability or recent joint surgery.
4. Bleeding disorders or being on anticoagulant medications.
5. Pregnancy, especially during the first trimester, and breastfeeding.
Further information can be found here: musculoskeletal cortico-steroid injection treatment.
Dynamic Regenerative Medicine
01564 330772