To Inject Or Not To Inject That Is The Question?

When having a steroid injection to combat pain, this is usually given by the healthcare professional alongside anaesthetic. This gives immediate pain relief, but dependent on the site of injection the length of relief will vary. Injections have been commonly prescribed in the treatment of tendinopathies, however, despite the widespread use, there is a controversy surrounding the usefulness and safety of the injections.

On the whole steroid injections have very mixed results depending on the site of injury. Short-term pain control, up to 6 weeks, has been reported as good in patients suffering from tennis elbow and shoulder impingement. However, the efficacy of the steroid injections for the long term has not been demonstrated. In comparison to rehabilitation with a qualified professional, the steroid injection provided no true long-term benefit (6-12months after).

In addition to the question of the efficacy of corticosteroid injections in the medium-term treatment of tendinopathy, there is a question of safety with using these medications in this setting. Several cases of Achilles tendon rupture have been reported after corticosteroid injections to this region. More recently, a study completed in 2004 described a series of 83 injections to the Achilles region without serious complication. These injections were performed under fluoroscopic guidance, simply put this is multiple x-rays taken in one go. Of note, only 40% of the patients in this series reported improvement after the procedure at the 2-year follow-up appointment. As previously mentioned, the effects of the steroid injection have shown to be beneficial in relieving pain in thew short term, but how does the combination of steroid and anaesthetic affect the body?

The healthcare professional will combine the steroid with an anaesthetic to provide an immediate pain relief. It has been reported that there are significant negative effects on tendons when a steroid injection is administered. There is an increase in collagen disorganisation, reduced collagen production and a decrease in cell proliferation. Further to this, the mechanical properties of the tendon are significantly reduced. So what does this mean?

It has been reported that the use of a corticosteroid injection has caused a decrease in the tensile strength of isolated fascicles but it is unknown how the injection affects the whole tendon. This weakening, can make the tendon more susceptible to rupture. It does boil down to what you want. IF you have been suffering with this pain for a long period of time and rehabilitative exercises are showing no signs of improvement, then yes maybe think having an injection to allow you to perform pain free. Remember, this lasts up to 6-weeks maximum, you may only have relief for a few days. This is then tied in with the cost of the injection, unless you are willing to wait long periods of time to get referred on the NHS then you will go privately. This can cost more than £200 a time, and the fact there are no true long term benefits it is up to you whether you see if it is worth it.

All I can recommend is that you speak to a physiotherapist or a sports therapist so they can guide you on whats best for you. We are happy to answer any questions you may have contact or book in to work out whats best for you in the long term.

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