Ultrasound-Guided Steroid Injections

Patient Information

Depomedrone used in steroid injection therapy Steroid or corticosteroid injections can be used to reduce pain and inflammation arising from certain joints, bursae and soft tissues.

At Meyer Physio, steroid injections are performed following a clinical assessment and, where appropriate, diagnostic musculoskeletal ultrasound. Injections are performed using real-time ultrasound guidance, allowing the clinician to visualise the needle and target structure during the procedure. Ultrasound guidance improves the accuracy of needle placement for many musculoskeletal injections, although improved accuracy does not necessarily mean better long-term outcomes for every condition.

What is a steroid injection?

Steroids are anti-inflammatory medicines. When injected into or around an inflamed joint or soft-tissue structure, they can reduce inflammation and provide temporary pain relief.

At Meyer Physio we commonly use methylprednisolone acetate when a steroid injection is clinically appropriate.

A local anaesthetic may also be used during the procedure to improve comfort and may provide temporary pain relief immediately afterwards.

What conditions can steroid injections help?

Steroid injections may be considered for conditions including:

Osteoarthritis with an inflammatory flare or synovitis
Frozen shoulder (adhesive capsulitis)
Subacromial-subdeltoid bursitis
Acromioclavicular joint pain
Certain forms of hip bursitis
Knee, ankle, wrist, hand and foot joint inflammation
Trigger finger
Some tendon-sheath conditions
Other inflammatory musculoskeletal conditions where clinically appropriate

A steroid injection is not appropriate for every painful condition.

Your clinical examination and ultrasound findings will be considered together before deciding whether an injection is likely to be helpful.

How effective are steroid injections?

The response varies according to the condition being treated.

Steroid injections generally provide short-term pain relief, often lasting from several weeks to a few months. They do not cure osteoarthritis or reverse structural changes within a joint or tendon.

Reducing pain and inflammation can, however, provide a useful opportunity to restore movement and progress rehabilitation.

For this reason, we usually regard an injection as part of a wider treatment programme rather than a stand-alone treatment.

Why does Meyer Physio use ultrasound guidance?

Ultrasound allows the clinician to see the relevant anatomy and needle in real time.

This can help:

confirm the intended target;
improve needle-placement accuracy;
avoid important neighbouring structures;
identify and aspirate an effusion where appropriate; and
confirm distribution of the injected medication.

Evidence supports improved accuracy with image guidance for many injections, particularly for joints that are difficult to access. However, the evidence does not show that ultrasound guidance produces superior long-term outcomes for every injection or every condition.

This is why we prefer to describe ultrasound as improving precision and procedural confidence, rather than promising a better clinical result.

What happens at the appointment?

Before proceeding, your clinician will review your medical history, current medication and the potential benefits, alternatives and risks of treatment.

Please tell us if you:

have diabetes;
take anticoagulants or other medicines affecting bleeding;
have recently taken antibiotics or currently have an infection;
have had a recent vaccination;
are pregnant or breastfeeding;
have glaucoma;
have previously reacted to steroid or local anaesthetic;
are awaiting surgery or joint replacement; or
have recently received another steroid injection.

The skin is cleaned using an antiseptic solution and the procedure is performed using an aseptic technique.

The needle is then guided to the required location under ultrasound.

Most procedures take only a few minutes.

What should I expect afterwards?

If local anaesthetic has been used, the area may initially feel significantly more comfortable or temporarily numb. This effect wears off.

The steroid itself usually takes longer to work. Improvement may begin within several days, although the response varies between individuals.

Some patients experience a temporary post-injection flare, with increased pain for approximately 24–48 hours before symptoms settle.

What should I do after the injection?

We generally recommend relative rest and avoiding strenuous use of the injected area for approximately 24–48 hours.

Complete immobilisation is not normally required.

Your clinician will provide advice appropriate to the particular joint, tendon or bursa treated and will explain when you can resume exercise and rehabilitation.

What are the risks?

Steroid injections are commonly performed and serious complications are uncommon, but no injection is completely risk-free.

Potential side effects include:

temporary increase in pain following injection;
bruising or bleeding;
facial flushing;
temporary menstrual disturbance or vaginal bleeding;
temporary rise in blood glucose;
skin thinning or loss of subcutaneous fat around the injection site;
temporary or permanent change in skin pigmentation;
allergic reaction;
infection; and
temporary systemic effects from absorption of steroid.

Repeated or higher-dose steroid exposure may also have adverse effects on cartilage, bone and other tissues. For this reason, injections should be used selectively and at the lowest effective dose rather than simply repeated routinely.

Steroid injections and tendons

Steroids are not normally injected directly into tendon substance.

Intratendinous steroid exposure may weaken tendon tissue and tendon rupture has been reported following steroid injections, although the magnitude of risk varies according to the tendon, pathology and injection technique.

Where an injection is considered around a tendon or tendon sheath, the potential benefits and risks will therefore be assessed carefully.

What if I have diabetes?

Steroid injections can temporarily increase blood glucose.

This is particularly important in people with diabetes. The rise commonly occurs during the first 24–72 hours, although glucose may remain elevated for longer in some patients. Current guidance recommends careful glucose monitoring for at least 48 hours and until levels return to normal.

If you have diabetes, please tell your clinician before the injection and discuss what monitoring may be required.

What if I take blood thinners?

Do not stop anticoagulant medication yourself.

Many musculoskeletal injections can be performed safely while patients remain anticoagulated, depending upon the medication, injection site and individual bleeding risk. For example, current evidence supports performing intra-articular injections in appropriately controlled patients taking warfarin without routinely stopping treatment.

Please tell us about all anticoagulants and anti-platelet medication before your appointment so that your individual risk can be assessed.

Can steroid injections damage cartilage?

This is an important question.

Evidence suggests that repeated intra-articular steroid injections may be associated with a small amount of cartilage loss, particularly with higher cumulative exposure. This does not mean that an appropriately selected single injection is unsafe, but it is one reason we do not recommend repeated injections simply because a previous injection helped.

The benefits and potential risks should be reconsidered before each injection.

How often can I have a steroid injection?

There is no scientifically established rule that applies equally to every patient, joint and condition.

Traditionally, clinicians have often limited injections to approximately three or four per joint each year, but EULAR notes that this convention is not based on strong research evidence.

Current guidance favours using the lowest effective dose, allowing an appropriate interval between injections and considering cumulative steroid exposure rather than automatically repeating injections on a fixed schedule.

At Meyer Physio, repeat injections are considered individually.

What if I am awaiting joint replacement surgery?

Please tell us if you are awaiting hip, knee or another joint replacement.

Current evidence suggests an increased risk of postoperative deep joint infection when an intra-articular steroid injection is given shortly before replacement of the same joint. Current guidance recommends avoiding injection into a joint scheduled for replacement within approximately three months, particularly during the final month before surgery.

If surgery is planned, we may recommend discussing the proposed injection with your orthopaedic surgeon.

Pregnancy and breastfeeding

A musculoskeletal steroid injection is different from taking prolonged systemic steroid treatment.

Pregnancy or breastfeeding does not automatically exclude treatment, but the decision should be made individually after considering the indication, medication, dose and alternatives.

Please tell Suegnet if you are pregnant, may be pregnant or are breastfeeding before treatment.

Can I drive afterwards?

This depends upon where you have been injected and how you feel afterwards.

Local anaesthetic may temporarily cause numbness or weakness. An injection into a lower-limb joint may also temporarily alter comfort or control.

We therefore recommend discussing driving with your clinician before leaving the clinic. If you have significant numbness, weakness, dizziness or difficulty controlling the limb, do not drive until these effects have resolved.

When should I seek medical help?

A temporary increase in discomfort following injection can occur.

However, you should seek urgent medical advice if you develop:

rapidly increasing pain;
increasing redness, heat or swelling around the injected area;
fever or feeling systemically unwell;
significant unexpected weakness or numbness; or
symptoms of a severe allergic reaction.

Joint infection following steroid injection is rare, but requires urgent medical assessment.

Alternatives to steroid injection

Depending upon your diagnosis, alternatives may include:

activity and load modification;
physiotherapy and progressive rehabilitation;
appropriate analgesic or anti-inflammatory medication;
aspiration of a symptomatic effusion;
hyaluronic acid injection for selected patients with osteoarthritis;
other injection treatments where supported by the diagnosis; or
referral for further imaging or specialist medical/orthopaedic assessment.

Your clinician will discuss the available options with you before proceeding.

Our approach at Meyer Physio

An injection should have a clear clinical indication.

At Meyer Physio, the decision to inject is based on your history, clinical examination and imaging findings where appropriate.

An abnormality seen on ultrasound does not automatically require an injection, and an injection will not be recommended simply because it is technically possible to perform one.

Our aim is to identify the likely source of your symptoms and determine whether steroid injection is an appropriate part of your overall management and rehabilitation plan.

Informed Consent Form:

Please read this information before signing the consent form. You will also have an opportunity to discuss any questions with your clinician before deciding whether to proceed.

Please sign Informed Consent for steroid injections