Cortisone injection referral guide

Having a steroid injection is generally a safe procedure and is a firmly established treatment for patients with an inflammatory condition that is causing pain.

The injection delivers two medicines into or near the painful area or joint. You will receive a local anaesthesia (Lidocaine) followed by a corticosteroid (Methylprednisolone or Triamcinolone).

The local anaesthetic is used to block pain from the injected area. The corticosteroid is used to reduce swelling and inflammation in the injected area.

The local anaesthetic injection gives immediate relief while the slower acting steroid injection takes effect.

What are the risks?

Significant, unavoidable or frequently occurring side effects or risks: local injection site pain, post injection flare, facial flushing, nausea, mild abdominal pain, fluid retention, a temporary rise in blood sugar levels (diabetes) and menstrual irregularities (in women).

Rare complications: allergic reactions (anaphylaxis), infection, vessel injury, nerve injury, altered skin depigmentation, subcutaneous fat atrophy, tendon damage, uterine bleeding, no improvement of symptoms, worsening of symptoms, and recurrence of symptoms.

If you have diabetes and your blood glucose level is not well controlled, please inform the injection therapist. After having the injection, you are advised to check your blood sugar levels more frequently that day. There is evidence that steroid treatments may increase the risk of harm from viruses such as coronavirus and influenza, but only if you become infected with them. Further research is looking into this, but due to these potential risks we are currently offering steroid treatments to patients who are likely to benefit the most and where other treatments have not helped to manage symptoms.

You have been asked a series of questions today to make sure there are no reasons why the injection cannot be given at your injection appointment.

Examples of situations where a steroid injection cannot be given

These include:

• If you have had, or are due to have, a live vaccination within two weeks of cortisone injection. Steroid joint injections should be avoided for two weeks after the administration of a COVID vaccine.
• If you have any medical procedures or surgery requiring general anaesthetic less than six weeks before or six weeks after the steroid injection.
• If you are taking antibiotics, you will need to rearrange your appointment as the course of antibiotics must be completed, and symptoms subsided before you can have the steroid injection.
• If you are unwell - high temperature, new continuous cough, loss of smell or taste.

If you take Warfarin medication:

• Your INR must be checked within seven days before your appointment time
• Your INR must be within your therapeutic range
• There should be no changes to your medication. Please bring your yellow book with you as confirmation, or the injection cannot be given

After your steroid injection, it is advised you stay in the waiting area for 20 minutes, to make sure you feel fine before you leave the department, this is because some people can experience side effects or feel unwell up to 20 minutes after the injection.

To get the maximum effect from this treatment it is important that you: Rest the injected part for the first two to three days. During the first 24 hours move the affected joint gently to aid the dispersion of the drugs used and avoid repetitive movements. Avoid previous activities that aggravated your condition. You can gradually resume normal activities, within two to three days, stopping if possible if this causes you undue pain.

It is preferable to avoid strenuous activity for up to six weeks after the injection. If you are unsure whether you should avoid an activity, please discuss this with the therapist who gives you your injection.

Contact information

01744 415570

Fiona Dance (St Helens)

Richard Gregory (Knowsley)