Rheumatology and

Musculo-skeletal Clinic

 
 

Soft tissue areas commonly treated by corticosteroid injection therapy


Shoulder/Rotator Cuff Injuries

    subscapularis

    supraspinatus

    infraspinatus

    teres minor

    acromioclavicular joint

    coracoid attachments

    levator scapulae

Elbow Injuries

    lateral epicondyle

        (tennis elbow)

    medial epicondyle

        (golfers elbow)

    annular ligament

        (radial ligament)

Hand Injuries

    carpal tunnel syndrome

    De Quervain’s tenosynovitis

Hip Injuries

    greater trochanter

    ischial attachments

    pubic tubercle attachments

        (pubic spine)

Knee Injuries

    medial collateral ligament

    lateral collateral ligament

    anserine bursa

Foot Injuries

    tibio-calcaneal ligaments

    tibeo-navicular ligaments

    calcanean spurs

    plantar fasciitis

   

 

Corticosteroid Injection Therapy


Corticosteroids have been used for decades to treat soft tissue injuries.  The results have varied according to where the injections were placed.  For example, injecting into the body of the deltoid with a large dose of steroid (40mg) for a shoulder injury, may be painless, but may only give relief from a few hours to 6 weeks.  Alternatively, injecting at the enthesis (where the tendon inserts into the bone) with 1/10th of that amount of steroid for a specific shoulder injury such as a supraspinatous injury, into the actual tender spot, has a 90% cure rate for that specific injury.* The corticosteroids are usually mixed with local anaesthetic to give immediate relief, and to assist with the actual injection process.


At doses of 4 mg of a slow-release corticosteroid (triamcinolone), the risk of side-effects is minimal.  The most common side-effect is momentary pain as the doctor treats the injured point.  If it is not tender then the doctor is not in the right spot.  Some diabetics may get a small, temporary rise in sugar levels.  The risk for tendon or ligament damage at the low dose of 4 mg has never been recorded.  (At 40 mg doses, some tennis elbow treatments have caused rupture of the tendon and skin death (necrosis)).


Steroid doses of 40 mg are still used in inflammatory and gouty large joints, with good effect.  Smaller doses are used for smaller joints.


Many occupational overuse syndromes (OOS) (repetitive strain injuries (RSI)) are due to soft tissue injuries, and are commonly treatable.


Following corticosteroid treatment, patients are recommended to not over-strain the injected area for a six-week period, as the injection only turns off the painful inflammatory response, and the healing still has to take place.  Healing of any injury usually takes 6 weeks: where an injury has become chronic, it appears that this healing process has been altered.  Therefore, once treated with steroids, the healing process needs to be completed naturally.