Having a Steroid Injection

Steroid is a powerful anti-inflammatory drug, used to treat many conditions around the hand, such as arthritis, trigger finger, carpal tunnel syndrome and tendonitis.

There is good evidence that steroids can reduce the ability of the body to fight off infection, by dampening the immune response. As a result, current guidance is that steroid injections should be avoided where possible. There is no good evidence to say what exactly the risk to healthy individuals is, although the doses of steroid used to treat hand conditions are small. This risk, however, should be considered if you choose to have a steroid injection as treatment for a hand problem.

What should I expect afterwards?
Often the steroid is injected with a combination of local anaesthetic. The anaesthetic will wear off within a few hours, and most people have increased pain for a few days after the injection. This is because an injection of fluid into a tight space always increases the pressure, and this increased pressure causes pain. Pain can usually be managed with simple painkillers such as paracetamol or ibuprofen. Occasionally pain is very severe and this is known as a ‘steroid flare’. Steroid flares take several days to settle and can be very uncomfortable, but do not cause major harm.

What are the Complications of Steroid Injection?
Skin / fat necrosis
In some patients, the skin or fat next to the site of injection breaks down and can make the area look abnormal, with discolouration of the skin and a hollow appearance to the underlying fat. 

This is a very unusual complication of steroid injection, but one that is very serious, and requires urgent attention. Symptoms of infection are redness, increasing pain and temperature, with loss of function. If you experience these symptoms, please contact us urgently or alternatively you should attend your GP or the A&E Department. 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 trigger finger rather than arthritis. This complication may require surgery to regain function, but permanent functional loss is likely if it occurs.

Artery or Nerve Damage
Injection of steroid directly into an artery can cause thrombosis of the artery, and potentially cause gangrene of the affected finger or thumb. Injection directly into a nerve will damage the nerve tissue and can produce loss of sensation and chronic pain from the nerve.

Altered Blood Sugars
This is particularly pertinent in those patients with diabetes. Steroid injections can raise the blood sugar (glucose) levels. It is therefore vital that regular monitoring of blood sugar levels is performed following a steroid injection, and if taking insulin, the dose is tailored accordingly.

Complex Regional Pain Syndrome
CRPS is a rare but very serious complication following surgery to the hand or arm, affecting 1 in every 10 000 patients. It causes pain and increased sensitivity, swelling and stiffness in the hand. It can be treated with physiotherapy and medical therapy. It can take up to 2 years to improve. Long term disability is common following this complication.

© Fife Hand Service 2021

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