A cortisone or steroid injection is at a basic level an anti-inflammatory medication. A cortisone injection is injected directly at the site of inflammation and tends to be more potent/stronger than simple tablet non-steroidal medication for inflammation (e.g. ibuprofen and naproxen).
Cortisone injections are normally used for inflamed tissues. When tissue is inflamed people often (but not always) report pain at rest, pain stopping them sleeping at night, and point tenderness. Some people have known arthritis that flares from time to time and needs something to settle it. Other people use injections to manage pain because for medical or other reasons they cant or don't want to have a surgery. Injections can also be helpful in the short term to facilitate physiotherapy exercise.
Generally a cortisone injection is a very low risk procedure. It is incorrect to say there are no risks.
- As with any procedure (like going to the dentist) you will always be advised on the risk of infection (but again very low with the sterile technique used).
- There is some evidence that too many (repeated) injections (>3 per year) over time (years) may predispose tissue to risk of weakening (but no particular evidence on a single small dose injection) .
- When injecting very superficial tissue structures there is a chance of skin de-pigmentation (skin becomes slightly lightened over a 2 pence area, link).
- Post injection pain for a few days after the injection can also occur (its likely this is no worse pain that you were already experiencing from the inflamed structure), similar to other risks this is low.
- The injection might not work, this is rare. Sometimes people one injection helps and a second is required. Sometimes e.g in non-inflammatory pain an injection only helps for a few weeks.
An aspiration is very similar to an injection in that the same needle is used, the structure is normally injected with local anaesthetic first. The aspiration part refers to fluid (likely swelling) being removed (sucked it out) via syringe. This might be used for conditions like Bakers or Ganglion Cysts, or very effused (swollen) joints.
Normally people who seek a private injection procedure have some understanding of its use, possibly they have had one before, their GP or consultant has advised it as a management option. People who have arthritis flare ups are commonly injected, they understand that injection can reduce the painful flare up but not cure the osteoarthritis itself. Other conditions like frozen shoulder, trigger finger and carpal tunnel can be caused by injury or predisposed by metabolic change and in such cases injections can be used to improve the condition while a certain time factor is involved in the resolution of the condition. Essentially injection are considered and used dependent on condition particularly after simple conservative management, time and natural healing haven't helped (typically > 12weeks).
Injections seem to work differently for different people, dependent on severity of inflammation, stage of condition being treated, ability of the person to avoid aggravating factors after injection, other metabolic contributory factors, repetitive use of injections. Sometime people are happy to accept an injections short term benefit for a break from the pain for a number of weeks, in other conditions such as trigger fingers and bursitis injections can be very effective and completely resolve the condition.
One way to look at Injections are that they are designed primarily to manage inflammatory pain, one reason for doing this is to allow for and promote normal movement and exercise, essentially injections when combined with physiotherapy often give the best results. The consult and management involves advice on how physiotherapy and exercise should be utilised after the injection. Different condition require different physio prescription. After the injection information and advice is given from a physiotherapy and rehab perspective on how best to move forward with the diagnosed condition. In most cases after the injection a 5-7days are give to allow the injection to work (sometimes up to 2-3weeks). Then advice would be to slowly build back into exercise, movement and normal function after this. The main point being to give a few days to allow the injection to calm and reduce inflammation.
There is technically no limit, but repetitive use isn’t advised and they tend to be ineffective with repetitive use. Evidence from the literature found that in the past people who continued to use multiple injections per year over a number of years caused damage to the joint. Like any drug too much, and frequent use could have adverse effects. Evidence suggest not having more than 3-4 injections per year, but even this number isn’t really sustainable in the long term. Ideal the goal would be to only use 1 or 2 injections to try and manage the inflammation and use other conservative measures in combination to manage the condition. Its not that a person cant have any more injections, its more than with over use of injection they seem to become less effective. If they are used for pain that is not inflammatory they tend to be less effective. Ideally in an arthritic joint one might use injections once every 1 or 2 years to manage flare ups and possibly utilise for short term relief.
Online assessment form needs to be filled out. Ideally your GP is aware of you plan to consider an injection? Your GP details are requested that we can update them on the assessment and injection procedure
Whilst a person can have joint, tendon, nerve and muscle pain it may not always be suitable that an injection is carried out. Ideally , the reason we request a GP referral and the online assessment information is to try (to the best of our ability) screen persons as to their suitability for an injection. It may be that we suggest you don’t have an injection and in which case only be charged for the MSK assessment, diagnostic ultrasound report and advice on most suitable management option. A lot of the time injections suitability is termined by waying up the risks and benefit to an injection, all information, from what the person says, to the physical exam to the ultrasound exam is considered and information and advice on injection suitability given. Ultimately once the person understands the pros and cons of the injection…patient choice is at the heart of the final decision, but clinician safety and best practices and opinion is always documented and made clear.
A lot of evidence based practice suggests primarily managing tendon pathology with exercise and appropriate loading, particularly in younger people who are playing sport. That being said there are different types of injections that do not contain steroid that maybe suitable in certain circumstances. Tendon pathology in other persons not in competitive sport have other options.
