steroids- what to expect

I guess you are hoping for answers from other people who have had them done - I hope we get some as it woud be useful to have some quotes on here. There is a whole page of the site devoted to my answers to all the usual questions about steroid injections - go to 'Information for Kent Patients/Injection' - JB

Hi, I have had some yesterday. It may not be a pleasant experiences, but it is worthwhile to do it. The steroid injections gave my twin pain relief for 2.5 to 3 months. For me it was a shorter period of time (up to 6 weeks), but I hope now it will be longer. The injections are quick thing (5 min.) My surgeon cleaned the wrists first with ethanol, then looked for the right spot. The injections were painful for me (6-7 out of 10) because he had to inject the stuff quite slowly. The injections were a mix of steroids and local anesthetics. Afterwards my fingers were numb for an hour or so and I haven't had any strength in the hands, but then it was fine and a relief. So maybe you take someone with you if you need to go to your doctor by car. Over night the hands were really tingling, but the pain eased. Today the wrists are sore and a bit stiff, but I got told that is due to injected fluid which may irritated the nerve for a few days. And of course I got a small bruise at the left wrist. My surgeon does not like to give more than one steroid injection at all, because he says it may damage the tendons. Maybe Dr. Bland can say something to that? I wish you good luck and a good relief. Cheers, Moni

Hi chocolategirl,
the steroid injection itself it not a pleasant experience, but in my case it was worth to do so. I got pain relief for about two months from the steroid inejction. Maybe it is even longer for you. First the doctor or orthopaedic surgeon will clean the area, look for the right spot and then he/she will inject the steriods. I got told that needs to be done slowly, so it could hurt. In my case my doctor went down to the carpal tunnel bones and then pulled the needle a bit back, before he injected the steroids. After the first hand I felt light-headed, but that feeling was gone after a few minutes. I had the same experience as 'Moni', my fingers felt odd afterwards, were tingling and a bit numb, but after a few hours that was gone.It took a few days before I had the pain relief, but my GP said that first the local anaesthetics kicks in and after a few days the steroid injection will take effect.
I sincerely hope I do not put you off the steroid inejections. For me it was painful (6-7 out of 10 for the pain score), but it is worth to do so.
Cheers,
Twinnie

Tendon injury from steroid injection at the wrist appears to be very rare - at least I can find no satisfactoily documented evidence in the medical literature. The nearest we have seen is a tendon rupture which occurred two weeks after a steroid injection and, as these injuries can occur as spontaneous phenomena anyway, this is rather a tenuous connection. Most of the literature relating to steroids and tendon rupture relates to achilles tendons. There is one case of multiple flexor tendon rupture reported by Gottlieb and Riskin (1980) but this followed 29 local steroid injections to each wrist and even then it is not clear that it would not have happened anyway as a result of the patient's underlying disease. JB

Incidentally  - I would very much appreciate it if everyone who has a steroid injection performed in East Kent (or anywhere else for that matter) - would provide a report of how painful they found it, using the usual pain scoring convention of a scale from 0 - no pain at all, to 10 - the worst pain imaginable. Sampling by self report like this will not be truly representative but it would allow us to give a slightly more objective answer to the question 'will it hurt?' At the moment all we can say is that most patients do not find these injections very painful but a few do.. JB

Hi Chocolategirl, I have thought for a while how to describe the discomfort of the injection in a better way so that it is easier to imagine. Have you ever been to a dentist and got there local anaesthetics before the treatment? I would say the injection is less or equally painful as an injection with local anaesthetics from the dentist, but more painful than a vaccination or giving a blood sample. Maybe you are one of the lucky ones who do not feel any discomfort at all, what Dr. Bland pointed out above. ;) Kind regards, Moni

I attended clinic yesterday, looking at all the options, I decided to opt for the injection.Well I am now regretting making that decision.The wrist is such an awkward place to have an injection. The thought of it is making me feel quite sick, and I have not been given an appointment date yet!!!

The injection site is just above the wrist. In fact, exactly where you put it seems to make no difference to how effective it is as long as you are within a couple of inches of the carpal tunnel so most people now choose an injection site for both comfort and safety - which usually means about 1-2 cm up the arm from the wrist crease. The patient experience following injection is heavily modified by whether a local anaesthetic is included in the injection. If you do inject an anaesthetic as well as a steroid then you get exactly the same effect which is familiar to most people from dental anaesthetics - numbness of the affected area for a few hours afterwards. There has however never been any real logic to adding a local anaesthetic to this injection. It is certainly not there to influence the pain of the injection itself as the procedure is all over before the local anaesthetic has any chance to take effect. I have heard it argued that numbness in the median nerve territory after injection including anaesthetic proves that you got the injection in the 'right' place, but, as pointed out above, it makes no difference to the outcome where you put it so why does anyone care? We do not include a local anaesthetic.

In practical terms the majority of injections in East Kent seem to be pretty painless. I do make a point of asking people who I see subsequently how they found the injection and anecdotally speaking the vast majority of people find it to be a trivial, and near painless procedure. I would like to firm up that 'anecdotally', into some properly quotable evidence based on systematically collected patient reports but this does require some input from the patients themselves of course.

I have also replied regarding your specific circumstances in the Canterbury patients forum but I put the above here because it is of general applicability. I am moving the rest of this thread to the Canterbury patients forum. JB

Hi, from my experience more worrying than actually painfull, stiffness and achy after, but my treatment lasted 4 years so well worth it
good luck dont worry

I'm moving your next post into the Canterbury patients forum Peter and will reply there as it is really a different topic - JB