Risks and Potential Side Effects

1. Infection

2. Blood sugar

3. Wait at least 3 months between injections

Steroid injections are associated with several risks and potential side effects. Fortunately, serious complications are uncommon. However, every patient should understand the potential risks before proceeding.

The most important complication is infection. Although rare, septic arthritis can lead to permanent joint damage and requires emergent treatment. The needle can potentially carry bacteria into the joint. The injected corticosteroid blunts the immune response, raising the risk of infection. Precautions should be taken to ensure the procedure is carried out in a sterile fashion. Patients should be instructed to seek immediate medical attention if they develop increasing pain, redness, swelling, fever, or drainage following an injection. 

Allergic reactions to steroid injections have been reported, but are rare.

Post-injection flare is a more common complication. Some patients experience increased pain for 24 to 48 hours after the injection. This is thought to occur due to irritation caused by corticosteroid crystals and generally resolves with rest, ice, and time.

Bleeding is possible, including bleeding into the joint resulting in a painful hemarthrosis. However, current evidence suggests that most peripheral musculoskeletal injections can be performed safely without interrupting therapeutic anticoagulation.

Vasovagal reactions can cause patients to become light-headed or pass out. Clinicians should check in with the patient immediately following the injection to confirm that they are safe to continue sitting upright.

Patients with diabetes should be advised that blood glucose may increase for several days after injection. The degree of elevation varies substantially among individuals.

An injection given near a tendon can weaken the tendon and increase the risk of rupture. This is of greater concern with frequent injections in the same location.

Repeated injections into the same joint may accelerate cartilage degeneration. Some patients enjoy significant relief for a short while and return for another injection. These patients should be counseled about the potential chondrotoxic effect of the injection. Repeated corticosteroid injections may accelerate cartilage loss in some patients, particularly when performed frequently over many years. 

A common practice pattern is to require at least 3 months between injections and perform no more than 3 to 4 injections in the same location per year.

Other risks include facial flushing, thinning of the skin, subcutaneous fat atrophy causing dimpling, and skin discoloration from depigmentation.

Key Takeaways

1. The most important risk associated with corticosteroid injections is infection

2. Diabetic patients should monitor blood glucose carefully for several days after the injection

3. Wait at least 3 months between injections given in the same location