{"id":16079,"date":"2019-11-29T15:51:36","date_gmt":"2019-11-29T15:51:36","guid":{"rendered":"https:\/\/www.myhealthspecialist.com\/blog\/?p=16079"},"modified":"2026-01-09T07:08:13","modified_gmt":"2026-01-09T07:08:13","slug":"corticosteroid-injections-for-managing-musculoskeletal-injuries","status":"publish","type":"post","link":"https:\/\/www.myhealthspecialist.com\/blog\/2019\/11\/29\/corticosteroid-injections-for-managing-musculoskeletal-injuries\/","title":{"rendered":"Corticosteroid injections for managing musculoskeletal injuries"},"content":{"rendered":"\n
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Introduction<\/strong><\/p>\n\n\n\n

Corticosteroid injections (also known as \u2018cortisone\ninjections\u2019) are commonly used by sports physicians to treat musculoskeletal\ninjuries; they can help reduce pain, swelling and stiffness.<\/p>\n\n\n\n

Corticosteroid injection into joints (with\nhydrocortisone acetate) dates back to 1951, when it was performed by Dr Joseph\nHollander and his colleagues. Their work involved 1,300 patients and over 10,000\nhydrocortisone injections to various joints and soft tissue (such as bursae and\ntendon sheaths) over a period of 4 years!1,2<\/sup><\/p>\n\n\n\n

Things have changed a lot since those days. Up to\n15 years ago, it was corticosteroids that were injected for most\nmusculoskeletal conditions, essentially making it \u2018the tool for every job\u2019.\nThis worked well for some conditions, but was sometimes associated with side\neffects, especially if a patient was given repeat corticosteroid injections in\nquick succession. <\/p>\n\n\n\n

Side effects are generally uncommon, but can\ninclude localised skin pigmentation changes, lipoatrophy, calcification around\nthe joint, allergic reaction to the constituents, tendon rupture, avascular\nnecrosis, infection and systemic side effects. <\/p>\n\n\n\n

The most common side effect to occur is a \u2018steroid\nflare\u2019, thought to affect up to 1 in 20 patients injected.  This is an\nacute exacerbation of pain within 1-2 days of having the injections. Fortunately,\nit generally subsides quickly with a combination of rest, ice and oral\nanti-inflammatory medication (NSAIDs).<\/p>\n\n\n\n

What can corticosteroid injections be used to\ntreat?<\/strong><\/p>\n\n\n\n

The following parts of the body can be injected \u2013\njoints, tendon sheaths, ligaments, muscles, musculotendinous junctions and the\nintermuscular plane. In the spine, areas that can be injected include the epidural\nspace (epidural injections), facets (facet joint injections) and intraforaminal\nspaces (nerve root injections).<\/p>\n\n\n\n

There are some areas where corticosteroid\ninjections should be avoided, such as directly into tendons, nerves or vascular\nstructures. Increasingly, there is a move away from injecting corticosteroids\nfor tendinopathy (e.g. Achilles tendinopathy) as these conditions are primarily\ndegenerative in nature, not inflammatory. There is also a concern about\nrepeated injections increasing the risk of a tendon rupture.<\/p>\n\n\n\n

A wide range of clinical conditions may benefit\nfrom a corticosteroid injection. Examples include carpel tunnel syndrome, De\nQuervain\u2019s tenosynovitis, osteoarthritis, gout and rheumatoid arthritis. Spine\nconditions include degenerative disc disease, facet joint arthritis and nerve\nroot entrapment. <\/p>\n\n\n\n

Injections were traditionally given using\nanatomical landmarks as a guide (landmark-guided injections). With the advances\nin imaging, more and more clinicians choose to do these injections under\nimaging guidance (using an ultrasound, x-ray or CT to visualise the needle and\narea to be injected) for reasons of accuracy and safety. <\/p>\n\n\n\n

How do corticosteroids work?<\/strong><\/p>\n\n\n\n

Corticosteroids work in many ways to achieve their\neffects. These include reducing the inflammatory reaction, restricting\naccumulation of leucocytes and macrophages (types of white blood cells) and\ninhibiting enzymes that can destroy normal tissue indiscriminately.<\/p>\n\n\n\n

Additionally, new research suggests that corticosteroids\nmay help to reduce the formation of \u2018prostaglandins\u2019, which are known to cause\npain. <\/p>\n\n\n\n

Importantly, the act of introducing a needle to\ninjured tissue may in itself provide drainage and release of pressure. It may\nalso mechanically disrupt scar tissue in muscle. <\/p>\n\n\n\n

What do corticosteroid injections consist of?<\/strong><\/p>\n\n\n\n

Corticosteroid injections commonly consist of the\nfollowing medications: a corticosteroid (e.g. methylprednisolone\/triamcinolone\nacetonide\/hydrocortisone) and a local anaesthetic (e.g. short-acting lidocaine\nor long-acting bupivacaine). <\/p>\n\n\n\n

The local anaesthetic component may be injected\nfirst to reduce pain for the patient.<\/p>\n\n\n\n

Other options for treating musculoskeletal injuries<\/strong><\/p>\n\n\n\n

There is now a greater awareness of other injection\noptions. These include hyaluronic acid injections for arthritic joints,\nprolotherapy injections for treating lax ligaments and platelet-rich\nplasma (PRP) injections for tissues that have poor healing properties.<\/p>\n\n\n\n

In recent times, stem cell injections have become popular\ndue to their proposed regenerative properties. However, more research is needed\non its effectiveness and safety profile before it can be used more widely.<\/p>\n\n\n\n

\u2018Non-injection\u2019 therapies are also available for\ntreating musculoskeletal injuries. For example, there is a lot of research to\nsupport the use of shockwave therapy (SWT) for chronic tendon and soft tissue\ninjuries. It is also more acceptable to patients who are needle phobic and\nwould much prefer to avoid injections!<\/p>\n\n\n\n

Finally, there is a greater emphasis on the\nmulti-disciplinary team (MDT) approach, rehabilitation and\nprevention. Injections on their own, without counselling or referral for\nappropriate rehabilitation to physiotherapy and other allied health colleagues,\nis often associated with poorer clinical outcomes.<\/p>\n\n\n\n

Public perception<\/strong><\/p>\n\n\n\n

It may be helpful to mention that corticosteroids (which this article refers to) and anabolic steroids (which are used illegally as an ergogenic aid to stimulate muscle mass and therefore banned by anti-doping authorities) are not the same!<\/p>\n\n\n\n

References<\/a><\/p>\n

This article is for information only and should not be used for the diagnosis or treatment of medical conditions. myHealthSpecialist makes no representations as t<\/span>o the accuracy or completeness of any of the information in this article, or found by following any link from this article<\/span>. Please consult a doctor or other healthcare professional for medical advice.<\/span><\/span><\/h6>\n
\n\n\n\n
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Dr Rick Seah<\/a> 
MBBS MSc (SEM) MAcadMEd MRCGP FFSEM (UK) DCH DSEM (GB&I)
Consultant in Sport & Exercise Medicine<\/p>\n\n\n\n

Book an appointment with Dr Rick Seah<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Introduction Corticosteroid injections (also known as \u2018cortisone injections\u2019) are commonly used by sports physicians to treat musculoskeletal injuries; they can help reduce pain, swelling and stiffness. Corticosteroid injection into joints (with hydrocortisone acetate) dates back to 1951, when it was performed by Dr Joseph Hollander and his colleagues. Their work involved 1,300 patients and over… Continue Reading Corticosteroid injections for managing musculoskeletal injuries<\/a><\/p>\n","protected":false},"author":77,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[1],"tags":[],"yoast_head":"\nCorticosteroid Injections for Musculoskeletal Injuries | Dr Rick Seah<\/title>\n<meta name=\"description\" content=\"Learn how corticosteroid (cortisone) injections help treat musculoskeletal injuries. 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