One of the most common treatments offered to our patients is a steroid injection. A steroid injection is offered either as a primary treatment or in an attempt to avoid more significant treatments such as surgery. There is, however, an unrealistic fear of steroid injections that patients often have. Some fears and concerns patients have about steroid injections are founded, but most are unfounded. Many believe that there is an upper limit of steroid injections that they can receive. For instance if they received a steroid injection in a particular year they feel they cannot have another one. Some feel that the steroid injection will destroy their bones, and others believe it will make them gain weight. While all treatments have an element of risk, it is important to understand the true risks and benefits of any procedure.
We all produce steroids in our bodies. The adrenal gland produces steroids that increase in times of stress; these are naturally produced steroids. The steroids given in the doctor’s office are synthetically produced steroids, some of the common names being Cortisone and Kenalog. The purpose of these medications is purely to decrease inflammation. Naturally occurring steroids go into the bloodstream, while synthetic steroids are injected into a particular area of inflammation. While there is some absorption by the body, most of the steroid medication remains in the area into which it was injected, decreasing inflammation and thus pain. There is no upper limit to the amount the steroid injections patients can have; however, repeated injections to one particular area can lead to problems.
Steroid injections are used to treat a variety of problems in the musculoskeletal system. Some of these include bursitis of the shoulder, tennis elbow, trigger fingers, carpal tunnel syndrome, knee pain, and heel spurs. For these and other similar problems 1 to 3 steroid injections as an attempt to treat these conditions without surgery are reasonable. When these do not work your doctor will discuss surgery with you.
Although rare, it is important to understand that there are some risks with steroid injections. The most common risk is a steroid flare; this is an increase in the amount of pain that that commonly occurs the night of, or a day after, an injection and usually goes away by the second day. As with any invasive type of procedure, the risk of infection is always present. A particular risk exists for diabetic patients as steroid injections can increase your glucose levels substantially. This is dependent on the dose and on your particular sensitivity to the medication. Diabetic patients should inform their physician about their condition before receiving an injection.
The injection is usually not as bad as people think; it is given with a small needle with a large percentage of the medication being lidocaine or Marcaine, which are numbing medicines. It is therefore not usually necessary to give a numbing agent prior to the injection. The injections usually last anywhere between one and ten seconds and the numbness in the area begins almost immediately. It is important to discuss with your doctor how you feel immediately after the injection since if there is still pain there may be problems in other areas. It sometimes takes several days or even weeks for the full effect of the steroid injection, so be patient.