Post injection

I first had a steroid injection in my wrist in January for cts ,strange feeling in my hand and fingers but after 3 days all was good.
June the cts came back pain in wrist ,fingers and up to my elbow .
I returned to my doctor he told me I need an operation to solve my cts ,but as I'm having my other hand fused at the end of July
He gave me another steroid injection but told me it might not have the same effect as the first injection .

Within minutes of my second injection my fingers and thumb be came very hot and painful to move .
It is now 15days since my second injection my fingers (not little finger) are still painfully to move and touch ,it's hard to use this hand even to hold a knife or fork is painful.
My fingers feel maybe froze bit or burnt ?

After 9days I returned to the surgery ,a doctor gave me 30/500 co-codamol 1-2 tablets 4 times a day and inform me the doctor whom injected my must of touched a nerve .

I took these tablets for 4 days with no effect so retuned to my surgery and was seen by a different doctor who now has
Perscribed prednisolone5mg 6 to be taken in morning alongside 1omeprazole 20mg he informed me it will reduce the swelling.

I am worried my hand with cts has permently nerve damage or will not pain free before my other hand is operated on
In two weeks.


The most worried about complication of local steroid injection for carpal tunnel syndrome is accidental injection into the nerve. Usually this is avoided by asking the patient to report what they feel as the needle is inserted. If the needle hits the median or ulnar nerves it produces shock like sensations radiating into the fingers and if this is felt then the needle should be repositioned before anything is injected. If, despite these precautions, the injection is made directly into the nerve then one would generally expect the effects to be instantaneous, not a few minutes later, but this might be modified by variations in exactly what is being injected. In particular many people add a local anaesthetic to the injection and if a local is used then that will prevent the patient feeling much at all until it wears off. Because direct injection of the nerve is a very rare event it has not been systematically studied and we do not know that all the different steroid preparations available necessarily have the same effect, though there was an experimental study on animal nerves some years ago by Susan Mackinnon which suggested that some steroids might produce much more violent reactions than others in nerve. Other effects of local steroid injection include 'steroid flare' - increased pain in the region for a few days - and I have seen a couple of cases of damage to the circulation and gangrene of a fingertip. None of these sound a very good match for your symptoms at first hearing. 

The use of oral prednisolone and omeprazole to treat this is interesting. I am assuming that all this has gone on in general practice in the UK. As usual if I were trying to analyse this scenario in one of my own patients I would want to know what the nerve conduction studies looked like before the offending injection, what they looked like when repeated after the problem had arisen and, in this case, almost certainly what the ultrasound shows, as direct intraneural injection sometimes leaves imaging changes of focal swelling of the nerve if you get to look at it soon enough after the injury. JB


Thank you for your reply
I had a cortisone injection
I live in ramsgate which is within your east kent region
Why do my fingers still hurt ,


It looks as though I haven't seen you since 2005 so clearly there has been a lot of history since then - and presumably no recent nerve conduction studies. 'Cortisone' is a pretty generic term and they may have used all kinds of different steroids while telling you it was a 'cortisone' injection I'm afraid. I can look at this but I will need a referral from your GP. JB


Thanks for your comments
Hopefully my GP will send a referral for me to visit you
I the near future


The quicker the better if we are wondering about possible intraneural injection - if they call me or fax through a request I'll squeeze you into the Thursday clinic. I just can't do it without some kind of referral in the current incarnation of the NHS - it would cause too much trouble with the financial contracting. JB

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