Corticosteroids are a very powerful class of medications that are designed to significantly reduce inflammation. They are commonly administered by orthopaedic surgeons and sports physicians to provide short-term pain relief and reduce local inflammation of a joint, bursa, or tendon.

Some of the more common uses for corticosteroid injections include the treatment of: wrist tendons, elbow tendons, rotator cuff tendon, frozen shoulder, hip osteoarthritis and tendons, knee joint osteoarthritis, ankle joint, and achilles/plantar fascia tendons among others. 

From a physiotherapy point of view, the aim of the injection is to reduce the pain and swelling enough so we gain a window of opportunity to improve movement, strength and function. Unfortunately, corticosteroid effectiveness varies greatly depending on condition type and severity, individual differences, skill of administering the injection, mindset of the client, and subsequent management. Effectiveness of the injections can therefore last between a few days/weeks and over a year. 

Before we get to the nitty gritty of whether corticosteroid injections help, ask yourself a few questions….

‘How many corticosteroid injections have I had?’

‘Where did I have them?’

‘How many did I have in one joint?’

‘Did the injections help?’

‘What are the potential side-effects of corticosteroid injections?’

Like any drug taken, there is always the risk of side-effects, with the most-costly for corticosteroid being bone fracture, infection and bleeding. This severity of side-effect makes sense when we consider that the main ingredient is cortisone, the same hormone that is released by the body as a reaction to extreme stress. Cortisone elevates blood pressure and prepares the body for a fight or flight response. 

So, are corticosteroid injections safe and appropriate?

In some cases, it is appropriate for corticosteroid injection but not in as many as first thought. Recent research has placed the short and long-term effects of corticosteroid use on many conditions under the microscope with some alarming findings. In terms of short-term effects, tennis elbow common extensor tendon showed definite improvement with all other areas being found to have only possible benefit. #

Long-term effects for corticosteroid found that rotator cuff tendons, wrist tendon, plantar fasciopathy, gluteal tendon/bursitis showed no long-term benefit and not enough data to conclude long term harm.

With Achilles tendinopathy studies, there were no long-term benefits and had limited long-term safety data but a possibility of increased risk of tendon rupture. #

Despite the evidence for short term benefit of injections for tennis elbow, definite long-term harm is regularly found after 6 months. Similarly for knee and hip osteoarthritis injections, studies have found that it is likely to cause long-term harm and could even accelerate the arthritic changes! #

With the above information, clients should tread very carefully before agreeing to an injection recommended by doctors or other health professionals. Some questions you can prepare in advance when injections are suggested include: 

‘Is this injection really necessary?’

‘What are the risks in getting an injection here?’

‘Are there any other options?’

By asking these questions, an alternative or more effective path may be agreed upon, side-effects or harm are minimised, and you’ll feel more involved in the decision-making process. If you are not sure how to approach these questions or concerns with your specialist, your physiotherapist can often help facilitate this communication.

You can ask a physiotherapist about your unique situation by clicking the button below:

References:

# Orchard JW, 2020: British Journal of Sports Medicine (Corticosteroid injections: glass half-full, half empty or full ten empty).