A cortisone or steroid injection is an anti-inflammatory medication. Cortisone is injected directly at the site of inflammation (Joint or soft tissue) and may have more potency or strength compared with simple over the counter tablet non-steroidal medication for inflammation (e.g. ibuprofen and naproxen).
Patient Information Leaflet:
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.
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. For example the first 6months of a frozen shoulder are very painful, and possible a patient has x2 injections in this time to manage their pain (instead of high dosage of NSAIDs/Opioids, that don’t always help). Essentially injections are considered and used dependent on condition, particularly after simple conservative management, time and natural healing haven't helped (typically > 12weeks). There is always a balance to be struck between restoring movement, improving sleep and mental well-being and the risk/benefit of a one off steroid injection. This is for each person to decide for themselves how to move forward with their management.
There is no clear answer here. Injections seem to work differently for different people, for different conditions. Then dependent on severity of inflammation, stage of condition being treated, ability of the person to avoid aggravating factors after injection, other metabolic contributory factors e.g. Diabetes, and repetitive use of injections. So clearly a lot of variables. Suffice to say generally most people are helped and improve with the injection. Sometimes people are happy to accept an injection will work for a short term (2-3months), they understand this and need a break from their pain (even for a number of weeks), in other conditions such as trigger fingers and bursitis injections can be very effective and completely resolve the condition (so long as managed holistically afterward with physiotherapy and changes to health).
Injections primarily manage inflammatory pain. Mechanical pain (muscle stiffness, joint stiffness, physical joint disruption) is less likely to be helped in the long term with an injection. Assessment to understand the nature of your pain is important. There are however many arguments as to when to consider having an injection, sometimes we inject for diagnostic reasons, sometimes we injection after exhausting management, sometimes we inject to promote normal movement and exercise. It is important if considering an injection you have the correct expectations and a holistic approach. Understanding that injections facilitate recovery and are not normally the single treatment that will resolve all symptoms. Combining injections with physiotherapy for example often gives the best results. In most cases after the injection 5-7days are given to allow the injection to work (sometimes up to 2-3weeks to see maximum effect). 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.
Some people answer by saying you can have 3-4 injection per year. However, technically over a lifetime there is no limit, you could have x1 injection per year for 5 years for a severe knee OA and this works well for some. The message to get across here is repetitive use, in close succession isn’t advised (plus injections tend to be ineffective with repetitive). Evidence from the literature found that in the past people who continued to use multiple injections (injection every few weeks) caused damage to the joint. Like any drug too much, and too frequent use could have adverse effects. Evidence suggest not having more than 3-4 injections per year, but either way this number isn’t really sustainable in the long term. Ideally the goal would be to only use 1 or 2 injections to try and manage the initial pain and inflammation and then use or combine this with other conservative measures in to manage the condition. It’s not that a person can’t have any more injections, it’s more that we often see that with over use, the injection seem to become less effective. Again pain that is more mechanical and less inflammatory doesn’t seem to do as well. 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.
Use the email address or mobile number. Whilst you can self refer it is always best your GP is aware of you plan to consider an injection. Your GP details are requested so that we can update them on the assessment and injection procedure. Ideally the GP send a referral/brief letter requesting assessment and injection. This helps and improves holistic care and safety (as GP knows your medical history and suitability for as injection also).
Whilst a person may have joint, tendon, nerve or muscle pain, it may not always be suitable that an injection is carried out. Ideally, the reason we request a GP referral to try (to the best of our ability) screen a person 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. Injections suitability is determined by waying up the risks and benefit to an injection, all the information, (physical and ultrasound examination). 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, best practices and opinion is always documented and made clear.
This question is sometimes misinterpreted. It is in fact very difficult to injection into a tendon. There is a lot of resistance. Often the injection is done into the tendon sheath. Despite it being very difficult to actually inject into a tendon, the short answer is that we avoid injecting into tendons. A lot of evidence based practice suggests primarily managing tendon pathology with exercise and appropriate loading, and other shockwave treatments. That being said there are different types of injections that do not contain steroid that maybe suitable in certain circumstances such as high volume Achilles sheath stripping injections or injecting into tenosynovitis.
