Steroid injections can be performed in the out-patient clinic, treatment room or operating theatre. Many steroid injections can be delivered in the out-patient clinic, including those for trigger finger, De Quervain’s syndrome, thumb base arthritis, finger arthritis and wrist arthritis. However, some steroid locations are better performed under the guidance of ultrasound (in a treatment room) or X-rays (in an operating theatre).

More advanced arthritis (with greater narrowing of the joint space) may benefit from image-guidance. Image-guided steroid injections help to guide the needle and confirm the location before steroid is delivered.

For painful conditions like tendonitis (including trigger finger) and arthritis, steroid is usually injected in combination with a local anaesthetic. The local anaesthetic will provide some local pain relief for a few hours after the injection (the neighbouring fingers may also go numb with some injections). 

Before the injection, the overlying skin is cleaned to reduce the risk of infection. With you seated in a chair or lying flat, a sterile needle is advanced through the skin under clean (aseptic) conditions and a small volume of steroid (often pre-mixed with local anaesthetic) is injected from the attached syringe into the desired location. An adhesive dressing or Elastoplast is then placed.

After the steroid is injected, an adhesive dressing or Elastoplast will be placed. Light finger pressure at the site of the injection is often recommended for a few minutes, especially if you take blood thinning medications like Aspirin or Clopidogrel. Bruising in the region of the injection may occur.

Any local anaesthetic injected alongside the steroid will wear off in the few hours after the injection and altered sensation (such as hand or finger numbness) should return to normal.

Mild pain / discomfort

Most people will experience mild pain or discomfort at the site of the steroid injection for a few days (due to increased local pressure and irritation). This pain is usually well-tolerated and can be helped by taking simple pain killers, like Paracetamol or Ibuprofen.

Steroid flare

Up to 1 in 5 people (20%) will experience a more severe pain following a steroid injection, called a ‘steroid flare’ response. A steroid flare is harmless but can be very uncomfortable and take several days to settle. This pain can be helped by taking regular simple pain killers, like Paracetamol or Ibuprofen, using an ice pack and prioritising lighter activities. Steroid flares will settle with no long-term harm.

Benefits

The anti-inflammatory benefits of a steroid injection (including pain-relief) will often take more than 10-14 days to take effect.

For arthritis, such thumb base arthritis, a good and common response would be 3-6 months of improved pain. However, some will experience disappointing levels of symptom improvement, which is not possible to predict.

For trigger finger/thumb, symptoms of pain and triggering (finger clicking) will usually settle significantly (and may resolve completely and permanently) following a steroid injection. However, it is also not uncommon for triggering to return and a repeat injection can be considered if the first worked well. Those with diabetes or inflammatory conditions (such as rheumatoid arthritis) are more likely to get recurrent symptoms.

For other types of tendonitis (such as De Quervain’s syndrome), symptoms of pain will usually settle significantly (and may resolve completely and permanently) following a steroid injection. However, symptoms can return. Repeat injection can sometimes be considered if the first worked well, but can risk issues such skin and fat changes.

The commonest side effect after a steroid injection is a ‘steroid flare’ response, causing pain and discomfort in the days after injection in up to around 1 in 5 people (see above section). Bruising in the region of the injection may occur.

Skin and fat changes

In some patients the skin or fat at the site of injection breaks down and can make the area appear abnormal with skin discolouration (i.e. it looks paler) and a hollow appearance to the underlying fat. Skin discolouration can sometimes be permanent.

Infection

This is a very unusual complication of steroid injection, but one that is very serious and requires urgent attention. Symptoms of infection include redness, increasing pain and temperature with loss of function (e.g. difficulty using your hand). If you experience these symptoms please make urgent contact or alternatively attend your GP or the A&E Department of your local hospital. Infection can result in significant and sometimes catastrophic loss of function.

Tendon rupture

Although very rare, tendon rupture is occasionally seen following steroid injection. This is more likely if the injection has been given for a diagnosis of trigger finger (and if the injection has been repeated) rather than injections into a joint for arthritis. This complication may require surgery to regain function, but permanent functional loss is likely if it occurs.

Artery or nerve damage

Although very rare, injection of steroid directly into an artery can cause thrombosis (clotting) of the artery and potentially cause gangrene of the affected finger or thumb. Injection directly into a nerve will damage the nerve and can produce loss of sensation and chronic pain from the nerve.

Complex Regional Pain Syndrome (CRPS)

This is a rare but serious complication following a steroid injection to the hand, wrist or arm that can affect 1 in every 10,000 patients. It causes pain and increased sensitivity, swelling and stiffness in the hand. CRPS can be treated with hand therapy and medical therapy (such as special painkillers). It can take up to 2 years to improve and long-term disability is common following this complication. Its cause is not well understood.

Allergy

As with all medications, there is a small risk of an allergic reaction with a steroid injection. Very rarely, a serious allergy (anaphylaxis) can occur that will require urgent medical treatment.

Matthew will enquire regarding your known allergies before performing any injection.

Other

Those with diabetes may experience a short-term fluctuation (rise) in their blood sugar levels.

Further information regarding the risks of steroid injection can be found at the UK NHS website.

Further information regarding steroid injection is available at the Lothian Hand Unit website.