Steroid injections (also called corticosteroids) are powerful anti-inflammatories which are
commonly used to treat a range of conditions including trigger digit, de Quervain’s, arthritis at the base of thumb and sometimes ganglia.
Your hand specialist will inject the steroid close to the problematic site (tendon sheath, carpal tunnel joint etc) and may sometimes use X ray or Ultrasound guidance eg basal thumb joint.
Many patients will experience some localised pain or swelling at the injection site but this should settle fairly quickly and paracetamol can be helpful.
The injections can take a few days to start working (average 1 week) and their effects can be very long lasting. For trigger and De Quervain’s 75% of patients will not require any further treatments. A minority of patients will require a second injection and even fewer may require surgical treatment if the injections have not helped.
Risks of steroid injections include:
Depigmentation or blanching of the skin. This can be especially prominent in dark skinned people and is sometimes permanent.
Skin atrophy (thinning). The steroid damages fat cells so can cause a divot or depression in the skin contour which can be unsightly.
Steroid flare – excessive pain and swelling at the injection site. This is due to crystallisation of the steroid. Will usually settle with analgesia and ice packs
Elevated blood sugar – diabetics should monitor their blood sugars post injection. Rarely causes any serious issues.
Tendon damage – steroid can weaken a tendon and therefore your specialist will take care not to inject into the tendon. Patients are advised to rest a joint for a few days after the injection. It is thankfully rare.
Infection (deep) is thankfully rare (5 per 100,0000) but immunocompromised patients should inform their clinicians nonetheless.
Cartilage loss research – repeated injections can thin the articular cartilage. This is less relevant when joints are already damaged but nonetheless repeated and frequent injection of the same joint is usually avoided.
Frequently asked questions relating to steroid injections
How many injections can I have?
Usually about 3 well-spaced apart ( at least 3-4 months apart) injections are possible during the course of a year if necessary. Your clinician will advise on this.
Will I gain weight?
No, this is most likely with oral steroids only.
I have an infection – should I avoid the steroid?
Yes. Most clinicians will not want to inject a site where there is active infection so its best to defer.
I have recently been vaccinated – can I have an injection?
You could have the steroid injection about 2 weeks after the vaccine. This is to avoid the potential immunosuppressive effects of a steroid injection interfering with the body mounting a immune response to the vaccine.
I am breastfeeding or pregnant – should I avoid a steroid injection?
Discuss with your clinician but steroid injections are usually safe for women who are pregnant or breastfeeding. The injections are commonly used in these situations when pregnant women present with severe carpal tunnel or De Quervain’s syndrome.
I am on blood thinners, should I avoid steroid injections?
Discuss with your clinician but this would not usually preclude a steroid injection. Ensure the anticoagulation is well controlled to avoid excessive bleeding or bruising at the site.
I am diabetic/ epileptic/ hypertensive – can I still have a steroid injection?
Inform your clinician but these conditions would not usually preclude having a steroid injection. Blood sugar levels can be a bit high for a few days after the injections and diabetics are advised to monitor their blood sugars.
I am allergic to steroid injections?
This is rare but you must inform your clinician.
