Steroid Injections

There are basically two types of steroids. The first type includes the sex hormones estrogen and testosterone. These are NOT used for steroid injections. The second type is the corticosteroids (often called "cortisone"), which have powerful anti-inflammatory properties. These can be injected into joints or localized areas of inflammation to decrease pain and swelling.

Steroids can also be given by mouth. Because oral steroids can cause numerous side effects, they are reserved for selected and specific conditions. The risk of side effects is lower with injected steroids than with oral steroids.

Steroid injections are used to ease the pain and swelling associated with the inflammation of tendinitis, bursitis, arthritis, gout or any number of other inflammatory conditions. They are commonly usually used at the knee, shoulder, hip, elbow, wrist, and fingers. The injections will be more effective if the steroid can be placed into the precise area of inflammation. They are not as effective if the pain and inflammation is in a large or broad area.

When you have a steroid injection, a needle is inserted directly and precisely into the affected area. Steroid fluid is then injected to help reduce the inflammation in that spot or joint. By using an injection, your doctor can deliver a concentrated amount of medication into the area where you need it most. The effectiveness of a single injection is determined largely by the accuracy of needle placement. The tip of the needle needs to be in the exact location of greatest inflammation. You will be asked to identify the precise point of maximum tenderness to help guide the doctor during the placement of the injection.

Before the injection
Before a steroid injection, you should tell your doctor if you have had a recent skin or general infection. This includes severe infections such as tuberculosis (TB), but you should also mention minor infections such as colds. Make sure you give your doctor a list of ALL the medicines you are currently taking before the injection. This includes non-prescription and over-the-counter medications, especially aspirin, NSAIDs (ibuprofen, naproxen, Motrinâ, Nuprinâ Advilâ, Aleveâ etc.) or other "blood thinning" medications. You should also state whether or not you might be pregnant. Your doctor should also know if you have ever had a bad reaction to steroids or other medications especially local anesthetics such as lidocaine or novocaine. You should also be prepared to list all of your allergies, especially those to medications.

Complications and Limitations
Steroid injections are considered very safe. The major drawback is that they may not produce the desired relief and many patients actually hurt worse for a day or two after the injection. Rarely, they may cause infections, allergic reactions, or bleeding in the area of the injection. In addition, frequent injections into the same joint or region may cause a weakening of the bone, tendons, ligaments and other tissues. Repeated injections tend to be less effective at relieving the inflammation than the first ones. In other words, the third or fourth injection provides less relief and relief for a shorter period of time than the first injection. For these reasons, many doctors do not like to do more than three or four injections into the same area.

The Injection
The injection itself is completed while you are seated or lying down. You will likely be asked to hold the part in such a way to make the injection easier for the doctor. You will also be asked to identify the exact point of maximum tenderness. The area will be cleaned with an antiseptic solution. Usually the doctor will numb the skin with a cold solution or an injection using a very small needle. The "cortisone" (often combined with a local anesthetic) is then injected directly into the exact spot of maximum tenderness.

After the Injection
You should follow your doctor's instructions after the injection. You will usually be asked to limit your activity for several days after the injection. It is common for the pain to actually be worse for a day or two after the injection.

Make sure to call your doctor if you have severe pain, a fever, or any significant swelling or redness around the area of injection.