Ultrasound-guided steroid injections

Steroid Injections

Steroid injections, also called corticosteroid injections, are anti-inflammatory medicines used to treat a range of musculoskeletal disorders. Common examples of steroids include hydrocortisone, triamcinolone and methylprednisolone.

What is an ultrasound-guided steroid injection?

An ultrasound scan can detect needles and guide them to specific positions in the body.

What are the benefits?

Corticosteroids are a group of medicines that reduce inflammation, and therefore can reduce swelling and pain caused by inflammation. These are used with local anaesthetic, which will temporarily numb the area affected. In some cases a corticosteroid injection can aid in diagnosing your condition if it is not clear which is the particular area that is causing your pain.

What are the risks and complications?

Occasional side effects of a steroid injection include:

• A temporary increase in pain for 24-48 hours after the injection (called a ‘steroid flare’). If you experience a worsening in pain, it is advisable to take over the counter painkillers such as paracetamol or ibuprofen to relieve your discomfort. Discuss with your pharmacist if you are unsure if you can take or are on any other medication.
• Mild facial flushing, which may last for a few hours
• Menstrual cycle alteration
• Loss of fat at the injection site, which may cause dimpling in the skin and may be permanent
• Paler or darker skin at the injection site
• Diabetic patients may find their blood sugar levels rise for a few days after the injection.
• Bruising may appear at the injection site.

Rare complications of the injection include:

• Infection (occurs in approximately 1 in 10,000 procedures). If the area injected becomes red, hot and swollen, and/or you feel feverish, this will require antibiotics. It is important to seek an immediate medical review by your GP, or attend an Emergency Department.
• Bleeding into a joint or soft tissue. This is usually only a concern for people taking warfarin or similar anticoagulation (blood-thinning medicine).
• Allergic reaction to the local anaesthetic.
• When the area around a tendon or ligament has been injected, there is an extremely low risk of tendon rupture/tear. This most likely occurs due to overuse after the injection of an already inflamed/worn out tendon. The doctor performing the injection will assess the state of the tendon using the ultrasound scan before deciding whether to proceed with the injection.

Please bear in mind that your doctor has recommended you for this procedure because they believe that the potential benefits of the injection outweigh any potential complications. If you have any questions or concerns please do not hesitate to speak with your doctor.

Tell the doctor before having the treatment if you:

• Have had a steroid injection in the last few weeks – you usually need to wait at least 6 weeks between injections
• You’ve had 3 steroid injections in the last year – doctors usually recommend no more than 3 injections in the same area in the space of 12 months
• Have had an allergic reaction to steroid in the past
• Have an infection (including eye infections)
• Have recently had, or are about to have, any vaccinations
• Are pregnant or breastfeeding
• Have any other conditions, such as diabetes, epilepsy, high blood pressure, or problems with your liver, heart or kidneys
• Are taking other medicines such as anticoagulants (blood thinners) or antiretrovirals. If you take any medication for the treatment of HIV it is imperative that you get in touch with your HIV team to obtain an official clearance letter to allow you to proceed with this treatment plan.
• Are feeling unwell or do not want the injection or no longer have symptoms.

Are there alternatives?

Alternatives to the injection include lifestyle changes, physiotherapy and oral pain relieving medication. Surgery may be another option, which would need to be discussed with your specialist.

Preparation

No specific preparation is required for this procedure. You may eat and drink normally.

You may need to arrange for someone to take you home or take public transport as it is not recommended to drive or exercise for 24 hours after the procedure.

On the day

Please report to the Ultrasound Reception Desk, Imaging Department, 1^st Floor, Lift Bank D. Please arrive 15 minutes before your appointment to allow time for you to be booked in and relevant written consent forms to be completed. If you arrive late it may result in your appointment being rebooked for a later date.  

Who performs the procedure?

The radiologist or sonographer will perform a diagnostic ultrasound scan to confirm the location and extent of the problem as well as to check there are no other issues in the surrounding area.

The skin is cleaned with a sterile solution. Using the ultrasound probe, the needle is guided gently to the affected area and the medication is injected. The needle is removed and a plaster or dressing applied. The procedure usually takes 10 to 15 minutes.

Will you feel any pain?

The injection of corticosteroid and local anaesthetic will involve a small needle and will be similar to a blood test, if the area is very inflamed there may be more discomfort. Tell the radiologist if it is difficult to tolerate.

The injection may cause stinging briefly before the area becomes numb. There may be a pressure sensation or tightness for injections into joints.

What to expect afterwards

Immediately after the steroid injection, you may feel that your pain has gone or is significantly reduced. This is due to the local anaesthetic and the effect will last for a few hours. The steroid usually starts to work in two to three days, but may take longer. The effect of the steroid injection varies from person to person, and a few people may not experience any benefit. Symptoms can be relieved for a few weeks to a few months.

When can I return to work?

You can return to work as soon as you feel able to. However, it is advisable to have the rest of the day off work.

Contact Information

Imaging Department

1st Floor, Lift Bank D
Chelsea and Westminster Hospital
369 Fulham Road
London
SW10 9NH

If you need to change your appointment date or time, or if you require an interpreter for your examination, please contact the booking team on 020 3315 2785/3 (Mon–Fri, 9am–5pm).