Steroid injection: when it helps and why it is not done often

A steroid injection delivers a corticosteroid into a joint, a bursa or around a tendon to reduce inflammation and pain quickly. It does not cure the cause, but it buys time for exercise and other treatment to work. Steroid injections are given rarely and for a clear reason: frequent repetition weakens tissue.

What is a steroid injection

In Georgia and in Russian-speaking countries this injection is often called a “blockade”. It usually contains two things: a corticosteroid, which switches off inflammation, and a local anaesthetic, which reduces pain straight away. A corticosteroid is a synthetic version of cortisol, a hormone the body produces itself, which is why it is sometimes called a “hormonal” injection.

The word “blockade” is sometimes used for other injections too, so always ask what exactly the injection contains. This article is about steroid injections. Hyaluronic acid and PRP are different methods, and I have described them in separate articles.

A steroid injection can be given:

• into a joint: the knee, shoulder, hip or ankle;
• into a bursa, a small sac near a joint that fills with fluid when inflamed;
• around a tendon sheath or attachment, for example for a “locking” finger or at the plantar fascia under the heel.

When does a steroid injection help

A steroid works best where the main cause of pain is active inflammation. Where the problem is tendon wear or overload, its benefit is short-lived.

Condition	What to expect
Osteoarthritis flare, fluid in the joint	Quick reduction of pain and swelling, usually for weeks or a few months
Bursitis	Often a good result, especially if the cause, such as kneeling, has also changed
Frozen shoulder in the early, painful phase	Less pain, which makes exercise easier
Trigger finger	Often a good result
Tennis elbow	Pain eases quickly, but the long-term result does not improve
Achilles tendon	Usually not done: it raises the risk of tendon rupture

The effect is fast: the local anaesthetic reduces pain within hours, and the steroid starts working within a few days. How long the effect lasts varies and depends on how active the inflammation was and whether whatever caused it has changed.

How I give the injection: ultrasound guidance

I give injections under ultrasound guidance. The screen shows the needle, the joint, the tendon and any fluid, so the drug goes exactly where it is needed, and not into the tendon or next to it.

I do this for two reasons. The first is accuracy: an injection given “blind” sometimes misses its target, and then there is no result. The second is safety: the steroid must not go into the tendon itself, because it weakens it.

If there is a lot of fluid in the joint, I remove it before the injection. This eases pain straight away, and the appearance of the fluid tells us about the cause of the inflammation. I have written about aspiration separately: fluid in the joint.

The procedure is done as an outpatient and takes a few minutes. You go home the same day, with advice to spare the treated area for a while.

Why steroid injections are not done often

The main advantage of a steroid injection, its speed, is also its main danger. The pain goes away, but the cause stays: an overloaded tendon or a damaged joint. People feel well, return to full load, and the pain comes back.

With frequent repetition the steroid itself weakens tissue:

• tendons, which raises the risk of rupture;
• cartilage, when injections into the same joint are repeated often;
• with shallow injections, the skin and the fat beneath it, which can thin or lose colour.

That is why a steroid injection is one part of treatment and not a replacement for it. If someone needs injections more and more often, it is a sign that the plan needs to change.

What side effects does a steroid injection have

Most people have no problems at all. Possible effects you should know about:

• a temporary increase in pain in the first days;
• temporary facial flushing and a feeling of warmth;
• a rise in blood sugar for several days, which matters for people with diabetes;
• infection: rare but serious, which is why injections are given under sterile conditions.

Steroid injections and surgery

If a joint replacement is planned, there should be at least three months between a steroid injection and the operation. A steroid affects the risk of infection after surgery, so always tell me before an injection if an operation is on the agenda. I have written about hip injections separately: injection therapy.

Steroid, hyaluronic acid or PRP

	Steroid	Hyaluronic acid	PRP
What it does	Switches off inflammation	Improves the properties of joint fluid	Works through platelets from your own blood
How fast it works	Within days	Gradually, over weeks	Gradually, over weeks
How long it lasts	Weeks or a few months	On average 7-8 months, depending on stage	Varies
When it suits best	Active inflammation, bursitis	Early and moderate osteoarthritis	Osteoarthritis, long-standing tendon pain

When a steroid injection is not given

• when an infection of the skin or joint is suspected, or with a fever;
• while the diagnosis is unclear: we first need to know what we are treating;
• into the Achilles tendon and, in general, into tendons that carry heavy loads;
• with uncontrolled diabetes, until blood sugar is under control;
• if less than three months remain before a joint replacement.

Key points

• A steroid injection reduces inflammation and pain quickly, but it does not cure the cause.
• It works best with active inflammation: an osteoarthritis flare, bursitis and the early phase of frozen shoulder.
• Frequent repetition weakens tendons and cartilage, so steroid injections are given rarely.
• I give injections under ultrasound guidance.
• There should be at least three months between a steroid injection and a joint replacement.

On joint pain in general: joint pain. If pain lasts more than a week, book a consultation.