Understanding Corticosteroid Injections: Benefits, Risks, and What You Need to Know 

Corticosteroid injections (CSIs) are a widely used treatment option for a variety of musculoskeletal conditions, particularly when inflammation and pain are involved. These injections provide relief in cases where other treatments have been less effective, but they come with a set of potential risks and side effects that patients should be aware of before opting for this intervention. In this blog post, we’ll break down what corticosteroid injections are, how they work, their uses, risks, and the guidelines for their safe application. 

What Are Corticosteroid Injections?  

Corticosteroids are synthetic drugs that resemble cortisol, a hormone produced by the adrenal glands. Cortisol is crucial in regulating the body’s response to stress and inflammation, which is why corticosteroids are effective in reducing pain and swelling in conditions like arthritis, tendonitis, and bursitis. 

Typically, corticosteroids are injected directly into the affected area, and they may be combined with a local anesthetic to enhance pain relief. The idea is to reduce inflammation at the site and provide significant, albeit short-term, pain relief. 

Who Benefits from Corticosteroid Injections?  

Corticosteroid injections can be a game-changer for people dealing with joint pain, particularly in conditions where other treatments have failed. Some common conditions treated with CSIs include: 

• Osteoarthritis (OA) : In OA, corticosteroid injections can provide significant pain relief, particularly in the knee, hip, and shoulder joints. However, long-term use is generally discouraged because repeated injections can accelerate joint deterioration. 
  
  
• Frozen Shoulder: For people with shoulder pain, especially those with frozen shoulder, corticosteroid injections can help reduce inflammation and improve range of motion. 
  
  
• Tendon issues and Bursitis: CSIs are often used in cases of tendonitis and bursitis, where inflammation is present around the tendons and joints. 
  
  
• Carpal Tunnel Syndrome: For some individuals with carpal tunnel syndrome, CSIs can help reduce the inflammation around the median nerve, relieving pain and numbness. 
  
  
• Trigger Fingers: Corticosteroid injections are often the first-line treatment for trigger finger, offering relief in a large percentage of cases.

Risks and Side Effects  

While corticosteroid injections can be effective, they come with several risks. It's important for patients to weigh the benefits against potential side effects: 

Local Side Effects:  

• Joint Arthropathy: Long-term use may weaken the joint structure. 
  
  
• Tendon Weakening: Corticosteroids can weaken tendons and increase the risk of ruptures, particularly in places like the Achilles tendon. 
  
  
• Skin Changes: Some people experience skin depigmentation or thinning of the skin around the injection site. 
  
  
• Fat Atrophy: Repeated injections can cause the fat pad around the joint to shrink, potentially affecting joint function. 
  
  
• Post-Injection Flare: A small percentage of people experience a temporary flare-up of pain or swelling after an injection. 

Systemic Side Effects:  

• Impaired Blood Sugar Control: Corticosteroids can worsen blood sugar levels, particularly in people with diabetes. 
  
  
• Increased Blood Pressure: They may cause a rise in systolic blood pressure. 
  
  
• Facial Flushing: Some people experience redness or flushing of the skin, particularly on the face. 
  
  
• Mental Health Effects: In some cases, corticosteroids have been linked to mood swings or even psychosis. 
  
  
• Immunosuppression: Corticosteroids can suppress the immune system, making the body more susceptible to infections. 

When Should You Consider Corticosteroid Injections?  

Corticosteroid injections are typically considered when other conservative treatments, such as physical therapy, non-steroidal anti-inflammatory drugs (NSAIDs), or rest, haven’t provided adequate relief. In many cases, injections are recommended when pain limits the ability to engage in rehabilitation exercises or when surgery is not an immediate option. 

It’s important to understand that CSIs are meant to be a short-term solution. Long-term or frequent use is not recommended due to the risk of joint and tissue damage. Patients should always discuss their treatment options with their healthcare provider and consider the risks versus benefits. 

Written by Caitlyn Alexander derived from Nick Lavadas’ masterclass on physio network.