What Are the Side Effects of Steroid Injections and How Likely Are They to Occur?
We offer steroid injections as an effective treatment for many different conditions. Patients often ask us if steroid injections have side effects, and how likely they are to occur. Every medical procedure has some risk of side effects, but steroid injections seldom cause problems for the patient. At WestCare, we carefully evaluate patients to determine whether they are good candidates for steroid injections. We evaluate how likely the patient is to benefit from the injection and the risk of complications.
An Overview of Steroid Injections
According to the Mayo Clinic, doctors administer steroid injections to reduce inflammation and relieve pain in a localized area of the body. Most steroid injections, also called cortisone shots, go into a joint. Large joints like the hip or shoulder, and medium-size joints like the knee, elbow, wrist, ankle, or back can get steroid injections. Sometimes people get relief from cortisone shots in smaller joints located in the hands or feet.
The injection itself is typically a local anesthetic and a corticosteroid medication. The local anesthetic takes care of immediate discomfort, and the steroid works over time to reduce inflammation and pain. The injection procedure usually only takes a few minutes. Steroid injections are outpatient procedures that doctors perform in their offices, ambulatory surgical centers, or hospitals.
Possible Side Effects from Steroid Injections
Minor, temporary side effects, like facial flushing and a feeling of warmth, happen to some people after a steroid shot. More significant reactions are rare. Damage to the tissue in and around the injection site usually only happens after a person has a large number of injections into the same area without waiting long enough between shots.
Because injections administer the steroid locally only to the affected area, as opposed to taking steroid pills that would distribute the substance throughout the entire body, injections generally are a safer method of treating pain and inflammation than oral medications. In patients with diseases or injuries that leave them with extreme pain and inflammation, steroid pills might still be necessary in addition to steroid shots.
Doctors limit the number of steroid injections into a joint to minimize the risk of side effects. The Mayo Clinic says that cortisone shot side effects can include:
Nerve damage
Damage to cartilage in the joint
Infection of the joint
Death of bone close to the injection site
Thinning of nearby bone, also called osteoporosis
Discoloration of the skin at the injection site, turning light or white
Injection site thinning of skin and soft tissue
Rupture or weakening of a tendon
Temporary blood sugar elevation in people with diabetes
Temporary increase in swelling and pain in the joint for up to 48 hours, followed by relief from the temporary and chronic discomfort and inflammation
Temporary flushing and feeling of warmth of the face and chest
The typical limits of steroid injections are three or four injections a year, about six weeks apart or more. These limits are generalizations. The precise number of shots and time intervals will depend on many factors unique to each patient, like age, other medications, and underlying medical conditions.
It is essential to disclose all relevant information to the doctor to aid the assessment of your risk. Also, patients should follow the instructions from the doctor’s office about preparation before the injection and steps to take afterward to minimize the risk of side effects and maximize the benefits of the shot.
Some patients get long-lasting relief from their first steroid injection. Others do not see the results they wanted. Everyone responds differently to medical procedures. The guiding principle is to achieve the greatest benefits with the least risk. The Cleveland Clinic says that most people tolerate steroid injections well, and that they are one of the most effective treatments for certain types of pain.
Benefits of Steroid Injections
Steroid injections can reduce or eliminate intense pain, lessen inflammation, and allow a person increased function of the affected area. Usually, steroid injections do not cure the underlying condition, like arthritis, but they can alleviate some of the symptoms of the injury or illness. For some patients, the relief lasts for quite some time, while some other people only experience short-term benefits from the shot.
Epidural Steroid Injections
When spinal nerve inflammation causes intense pain and does not respond to other forms of treatment, an epidural steroid injection might be a viable option.
The epidural area is like a fatty insulation around the spinal cord and spinal nerves. The insulation protects the spinal cord and nerves from damage. The doctor uses a syringe to inject pain medicine into the epidural area at the level that controls the sensations for the area where the patient experiences ongoing pain.
Johns Hopkins University explains that injecting steroids into the epidural area can reduce inflammation in patients who have medical conditions that involve swelling in the spinal column. The back contains many narrow passages that nerves pass through on their way out of the spine to the arms, legs, and other areas of the body.
When there is inflammation in these narrow passages, nerves can get irritated or compressed, leading to pain. Left untreated, the pressure on a nerve could lead to weakness, chronic pain, and even paralysis.
Here are some conditions that can involve narrowing of the passages in the back:
Herniated, ruptured, or “slipped” disc. A disc is a gel-filled cushion between the vertebrae, which are the bones that run down the center of the back. If something pinches, compresses, or tears a hole in the disc, the gel-like substance can leak out and irritate the nearby nerves. The irritated surrounding tissue can swell, narrowing the passage through which the nerves travel out of the back.
Fractured vertebrae. When a bone in the spinal column breaks, a jagged edge can migrate outside of its intended location, even by a few millimeters. Because the anatomy of the back is so complex, a slight variation like that can impinge on the space where something should be. For example, the shifted bone fragment might intrude on space where the nerve is, squeezing the nerve into less space than it needs to have to function properly.
Bone spurs on the vertebrae or joints. Some medical conditions can cause a person to grow extra bone-like areas on the joints or vertebrae. Called bone spurs, these growths can be painful and can limit function.
Spinal arthritis is an inflammatory disease that involves inflammation and discomfort in the spine and joints. Inflammation in the back can be a vicious cycle because inflammation irritates nerves and surrounding tissues, which then swell, further compressing spinal nerves and causing more inflammation. Steroid injections do not get rid of the arthritis, but reducing the swelling and pain can stop the cycle of inflammation and discomfort.
Cysts in the joints of the back. Any abnormal growth in the joints of the back can cause inflammation, pain, and a loss of function. Cysts can compress spinal nerves, causing swelling and discomfort. As the cyst grows, the patient could develop paralysis or weakness in the part of the body the affected nerve serves.
Epidural steroid injections rarely cause serious complications. The few people who have any side effects tend to experience one or more of these temporary symptoms: increased pain for a few days, difficulty sleeping, anxiety, and “steroid flush,” which is a feeling of warmth and flushing of the face and chest. Rare severe complications include nerve damage, paralysis, allergic reaction, bleeding, and infection.
Other Conditions That Can Benefit from Steroid Injections
Cortisone shots can provide effective pain relief for many different disorders, in addition to spinal issues. Here are some other conditions for which steroid injections can reduce inflammation and minimize pain:
Bursitis
Bursitis is a disorder that affects the bursae around the joints. Bursae are little sacs that are filled with fluid. The Mayo Clinic says that the purpose of the bursae is to cushion the bones, muscles, and tendons near joints. When the sacs get inflamed, the patient has bursitis, a painful condition.
It is possible to develop bursitis near the big toe, heel of the foot, and knee. The more common locations for bursitis, however, are the hip, elbow, and shoulder. For most people, the discomfort of bursitis goes away in a few weeks by resting the joint. Sometimes, bursitis does not heal on its own with rest, and a steroid shot can reduce the inflammation and pain.
If you have a joint that looks red or swollen, feels stiff or aches, and hurts more with use or the application of pressure, you might have bursitis. The joint pain can become disabling. A person might lose the ability to move the joint. Some people get a rash on or around the joint. Sudden changes or worsening of the symptoms or a fever are reasons to see a doctor right away.
Although people of any age can develop bursitis, the risk of the condition goes up with age. Repetitive motions can increase the risk of getting bursitis. People with diabetes, gout, or arthritis can make a person more likely to develop the condition. Steroid injections can provide relief from bursitis.
Gout
Gout is a type of arthritis. According to the Centers for Disease Control and Prevention (CDC), gout tends to attack only one joint at a time, but it does so with a vengeance, causing extreme pain. Often, gout focuses on the joint of the big toe. Other commonly affected areas are the joints of other toes, the knee, and the ankle. Gout is usually only on one side of the body.
Gout can go into remission, but many people experience flares, when their symptoms return. There is no cure yet for gout.
You might have gout if you have intense pain in one joint of the foot, knee, or ankle. Gout often causes noticeable swelling and redness in the affected area. The joint can feel warmer to touch than other areas.
Hyperuricemia is a condition in which the body makes or retains too much uric acid. The uric acid can build up in tissues, fluids, and joints throughout the body. Hyperuricemia does not need to be treated unless it causes gout. Many people with hyperuricemia do not develop gout.
Because gout is an inflammatory condition, many people find steroid injections to be a godsend when it comes to managing their pain and inflammation. Cortisone shots do not cure gout, but they can increase the quality of life when a person has a flare-up of the disease.
Osteoarthritis
Osteoarthritis is the most common form of arthritis, as MedlinePlus of the U.S. National Library of Medicine explains. Osteoarthritis is also called degenerative joint disease. A person with swelling and pain in one or more joints might have this condition. As the arthritis worsens, the person might have diminished ability to move the joint.
Osteoarthritis (OA) sounds as if it would attack the bones, but it does not do so, at least, not directly. OA breaks down the cartilage in joints. Cartilage works like a shock absorber in joints. As we move, our bones would grind against each other at our joints if they did not have slippery tissue, cartilage, covering the ends of the bones and taking the force of the movement.
Because OA causes deterioration of the cartilage, the bones eventually rub against each other. That rubbing causes damage in the joint, damage that can be permanent. Steroid injections can reduce the inflammation and discomfort of OA in affected joints.
Psoriatic arthritis
People who have the skin disease psoriasis can develop psoriatic arthritis. Not everyone with psoriasis will have this type of arthritis. There is currently no cure for psoriatic arthritis, but, like other forms of arthritis, the therapeutic goal is to manage the pain and inflammation.
Flare-ups of the skin condition, which involves itchy patches of raised, red skin, do not always happen at the same time as flare-ups of psoriatic arthritis. The swelling, pain, and stiffness of psoriatic arthritis can range from mild to disabling. Steroid injections can help to manage the discomfort of this medical condition.
Rheumatoid arthritis
Many people confuse rheumatoid arthritis and osteoarthritis, but the symptoms are quite different. Unlike osteoarthritis, rheumatoid arthritis (RA) is an autoimmune disease.
Autoimmune diseases involve the immune system attacking the body’s tissues. RA can happen in any joint throughout the body. RA usually affects more than one joint, unlike gout. The wrist and fingers are the most common locations for rheumatoid arthritis.
When RA affects the joints, the person can experience stiffness and decreased function of the joint, as well as pain and swelling. Because it is an autoimmune disease, RA is not limited to the joints. RA can attack a person’s lungs, mouth, eyes, and other body parts.
The cause of RA is unknown, but scientists suspect that genetics, hormones, and environmental factors could play a role in determining who develops this disease. There is no cure for RA yet, but medications and treatments like steroid injections can help a patient manage the swelling and pain.
Tendinitis
Many people incorrectly self-diagnose that they have arthritis when they actually have tendonitis, or the reverse situation. It is easy to understand this mistake since, as the Arthritis Foundation points out, tendonitis hurts near joints. To further muddy the picture, some forms of arthritis, like gout, osteoarthritis, and rheumatoid arthritis, can cause tendonitis.
Tendons hold muscles to bones. Your muscles could not move your bones without tendons. Athletes and people over the age of 40 are more likely to develop tendonitis than other people.
The most common areas in the legs for tendonitis are in the ankle, knee, and calf. In the upper extremities, tendonitis tends to develop in the thumb, hand, wrist, elbow, bicep, or shoulder.
Repetitive movements and sports injuries are some of the most common causes of tendonitis. Tennis elbow and pitcher’s shoulder are types of tendonitis, even if the patient did not develop the tendonitis from playing those sports. Steroid injections can provide relief to patients with tendonitis.
Sports Injuries
Cortisone shots can aid in the healing process for a variety of sports injuries by reducing the inflammation and managing the pain of the injury. When appropriate, steroid injections can get an athlete back on the playing field quicker than some other treatment options.
At WestCare, our goal is to help you get the best quality of life possible so that you can stay active and healthy. Please call us to find out how we can help.