Ultrasound-Guided Corticosteroid Injections

Corticosteroids are strong anti-inflammatories that are used in the treatment of various musculoskeletal conditions. Local steroid injections can be a rapid and effective treatment for joint pain and inflammation, as well as for local tissue inflammation, such as bursitis. Corticosteroid injections are performed under ultrasound guidance to ensure proper placement of the needle. These are not benign medications and do not cure the underlying cause for inflammation but can be used as an adjunct to treatment by enabling patients to maximize physical therapy. While the inflammation for which corticosteroids are given can recur, local steroid injections can provide months to years of relief when used properly.

For this procedure, it is recommended patients avoid all blood thinners, such as aspirin or antihistamines, for one week prior to the procedure. We also recommend avoiding use of any non-steroidal anti-inflammatory (NSAID) medication for 24 hours prior to the procedure.

What to expect when preparing for your steroid injection

  • After the injection:
    • For lower extremity injections, high impact activities (running, jumping, spinning, etc) are NOT recommended for the first 48 hours
    • For upper extremity injections, heavy lifting and excessive upper extremity activities are NOT recommended for the first 48 hours
    • After that time, gradual return to full activities is encouraged. Jumping back into all activities full-force is not recommended.
    • If performing physical therapy, it can be started/resumed at least 48 hours after the injection
  • Risks of the injection
    • Risk of infection is present any time the skin is broken but is a low risk. Signs of infection include chills, fever, pain, warmth and redness around the injection site. If you have any of these symptoms after your injection, please call the office.
    • There is risk that the injection will not work in relieving symptoms. For this reason, injections are not typically the first line of treatment
    • Risk of skin blanching (turning white), skin dimpling, and fat necrosis/skin atrophy at the injection site. These risks are uncommon but can occur and may take up to one or more years to resolve. Rarely, they can be permanent.
    • Risk of post-steroid flare-up where pain and swelling may increase for the first few days post injection. This is a rare side effect and resolves within about 1 week. If this occurs, icing and compression are recommended.