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Dr John J Ryan Higher Diploma in Sports Medicine
About hydrocortisone injections, Knee, Shoulder, Hip, Golfer elbow, Tennis elbow and Plantar Fasciitis
Hydrocortisone injections – or ‘steroid injections’ – are a type of medicine known as a corticosteroid. Corticosteroids are not the same as anabolic steroids. Dr John J Ryan has worked with both professional rugby teams as a current IRFU member and with tennis players in Leinster for over 20 years in this area of medicine. After doing a higher diploma in Sports Medicine with the Royal College of Surgeons Ireland Dr Ryan extended his sports medicine service to tennis players and golfers.
Hydrocortisone injections are used to treat swollen or painful joints, such as after an injury or in arthritis.
The hydrocortisone is injected directly into the painful joint. This is also called an intra-articular injection. The joints most often injected are the shoulder, elbow, knee, hand/wrist and hip.
Hydrocortisone injections are also used to treat painful tendons and bursitis (when a small bag of fluid which cushions a joint gets inflamed). They’re sometimes used to treat muscle pain when it’s in a particular area.
The injections usually help relieve pain and swelling, and make movement easier. The benefits can last for several months.
Hydrocortisone injections are only available on prescription. They are given by expertly specially trained Doctor John J Ryan in his Private GP’s Surgery D2 Medical 4 Fitzwilliam Square East Dublin 2.
In an emergency, medical staff may give higher dose hydrocortisone injections to treat severe asthma, allergic reactions, severe shock due to injury or infection, or failure of the adrenal glands.
Key facts
- Hydrocortisone injections for joint pain work by releasing the medicine slowly into the joint. This reduces pain and swelling.
- After an injection, your joint may feel better for several months – sometimes as long as a year.
- Some people get increased pain and swelling in the joint where the injection was given. This pain tends to go away after a few days.
Hydrocortisone injections into the same place can be repeated up to 4 times a year – more often can cause long-term joint damage.
Who can and can’t have hydrocortisone injections
Adults and children can have hydrocortisone injections.
Hydrocortisone injections aren’t suitable for some people. Tell your doctor before starting the medicine if you:
- have ever had an allergic reaction to hydrocortisone or any other medicine
- have an infection (including an eye infection)
- are trying to get pregnant, are already pregnant or you are breastfeeding
- have recently had, or will soon have, any vaccinations
- Make sure your doctor knows if you have:
- any unhealed wounds
- an eye problems like glaucoma
- weak or fragile bones
If you have diabetes and monitor your own blood sugar, you will need to do this more often. Hydrocortisone injections can affect your blood sugar control.
How and when to have them
If the injection is for pain, it may contain a local anaesthetic.
You can go home after the injection but you may need to rest the area that was treated for a few days.
You can have a hydrocortisone injection into the same joint up to 3 times in a year.
If you have arthritis, this type of treatment is only used when just a few joints are affected. Usually, no more than 3 joints are injected at a time.
The dose of hydrocortisone injected depends on the size of the joint. It can vary between 5mg and 50mg of hydrocortisone.
Will the dose I have go up or down?
The amount of hydrocortisone in the injection could go up or down in future. It depends on how well the previous injection worked, how long the benefits lasted and whether you had any side effects.
Side effects
Most people don’t have any side effects after a hydrocortisone injection. Side effects are less likely if only one part of the body is injected.
Common side effects
The most common side effect is intense pain and swelling in the joint where the injection was given. This usually gets better after a day or two.
You may also get some bruising where the injection was given. This should go away after a few days.
Dr. John J Ryan Higher Diploma in Sports Medicine Royal College of Surgeons Ireland
Frequently Asked Questions
What Is a Knee Injection? How Does It Work?
Knee injection is a type of procedure in which medications are injected into the knee joint to treat the pain. Types of injections include steroid shots and hyaluronic acid injections. A steroid shot, (or a cortisone knee shot), works by immediately reducing inflammation in your joint. Hyaluronic acid is normally present in healthy knee joints and helps lubricate them. But people with osteoarthritis (joint inflammation) generally lack enough amounts of this gel-like, elastic fluid in their joints.
Benefits of hyaluronic acid injection:
- Replaces the elasticity of your joint fluid
- Improves lubrication
- Eases pain from osteoarthritis
- Improves mobility
- Increases your physical activity level
Are Knee Steroid Injections Safe?
Steroid injections are safe if used in appropriate doses. These injections are a common treatment for arthritis, tendonitis, and muscle and joint inflammation. To cure arthritis pain, the dosage of injections shouldn’t be more than four injections every 12 months.
Nevertheless, potential side effects can happen with larger doses and frequent use. Repeated steroid injections can cause arthritis aggravation, weakening of the tendons and bones, and gradual damage to the joint and its cartilage. Hence, their frequent use should be restricted.
Are Knee Injections Painful?
We have many skillful specialists that can painlessly perform this procedure. However, you can feel a slight discomfort at the injection site. By necessity, the doctor may inject a syringe into the knee joint and remove a small amount of joint fluid. It will alleviate the pressure and pain in the knee.
How Long Does It Take for the Knee Injection To Work?
Depending on the procedure type, it may take a few days or weeks for you to feel the effect of the injection. The physical nuances of a person also impact the symptom’s improvement. Some people feel instant relief while others should wait a few days. Hyaluronic acid injections, on the other hand, don’t offer instant benefits. Their effects begin roughly around the fourth week, with the maximum pain relief noted by the eighth week.
How Long Does a Knee Injection Last?
The effect of a steroid shot usually lasts from 6 to 12 months. The extent of the inflammation and overall health play a vital role in the duration of the injection effects. If you pair the injection with physical therapy or other rehabilitation treatments the relief can be prolonged.
What To Expect After the Knee Injection?
There are different outcomes depending on the kind of the issue and the injection’s type. Steroid injections help promptly relieve knee pain and inflammation. You may feel a temporal “steroid flare-up” in pain that can last two days following the injection. Afterward, the discomfort in your joint will reduce, giving you long-standing pain relief. Pain relief can recover your foot functions that have been impaired by inflammation. Another type of knee injection called visco-supplementation injection involves injecting a gel-like fluid called hyaluronic acid into the inflamed knee joint. With this knee injection, you may not feel any immediate benefit. Many patients report some pain relief after several weeks of the course of injections, while others may benefit even months after the first injection. Most patients experience the most significant pain relief between 8 to 12 weeks after starting the treatment. Moreover, you may experience some swelling, heat, redness, itching, rash, bruising around your joint, and a build-up of fluid in your treated knee. These reactions are usually mild and transient.
What Can I Do After the Knee Injection?
If there aren’t any issues after the procedure, you are free to go home. You may be advised to:
- Avoid strenuous activity for the next 48 hours, including swimming or running
- Do not take hot tubs
- Avoid exposure to something that can carry infection through the needle track for the next 24 hours
- Monitor for side effects, such as an allergic reaction or an infection
- Take pain relief medication if you feel discomfort
Light activities, like walking, are allowed.
How Long After a Knee Injection Can I Exercise?
Recovery after a steroid shot does not take much time. It’s highly advised to take a break for at least 24 hours. Resting the joint after the injection is important to allow the inflammation to lessen. Exercises that can strain the joint should be avoided for several days after the injection. It’s best to stay active once you can exercise without feeling the discomfort or pain. However, it’s dangerous to overexert. Overexertion can damage your knee joint, making the whole steroid injection treatment useless.
Can I Shower After a Knee Injection?
It’s okay to take a shower the same day. But, it is best to not take a bath, a hot tub, or go to a sauna or pool for at least 48 hours after the injection.
Are Knee Injections Covered by Insurance?
All insurance providers cover steroid injections. The chances of getting reimbursement increases if you feel no improvement after non-steroidal anti-inflammatory drugs, exercise therapy, and lifestyle changes.
For hyaluronic acid injections, most insurances cover it in case if:
- Your knee X-ray shows evidence of osteoarthritis
- You haven’t had any hyaluronic acid injections in the last six months
- Your symptoms are not getting better with medications or physical therapy
How Often Can I Get a Knee Steroid Injection?
The cartilage within a joint can be damaged by excessive steroid shots. So doctors monitor the number of cortisone shots given to a person. A knee steroid injection can be given 3-4 times per 12 months. We try to avoid repeating the procedure by making the first injection as effective as possible. Only if there’s a need, the procedure can be repeated. All the details can be discussed during your follow-up visit to a doctor.