Ask the Doctor: ‘Since breaking my hand, I’ve had a lot of joint pain. Do steroid injections work, and are they safe to keep getting?’

“I had an accident a number of years ago and broke my hand. Since then, I have been having a lot of pain in some of the joints. I get steroid injections for this pain and it really does help. I get one per year. My question is, are these safe to keep getting? Also, will they keep working or will their effects wear off the more I get them?”

Answer from Mr Muiris Kennedy, Consultant Orthopaedic Surgeon at Beacon Hospital

This question relates to the safety and effectiveness of repeated steroid use in the upper limb. Your question does not specify the joint involved, or indeed if the injections involve tendon sheaths or bursae. I will therefore give a broad overview of the different injection types and the advice from surgical societies dedicated to shoulder, elbow and hand pathologies.

Tendon sheath injections in the hand

These injections are very effective for diagnoses like trigger finger, De Quervain’s tenosynovitis and ECU tendonitis. The literature evidence is that following a first injection, 50% of people experience a recurrence of their symptoms after four to six months. A second injection should then be tried. If the symptoms recur for a second time, then surgery should be offered to effect a permanent cure.

Small joint arthritis injections in the wrist and hand

Small joint injections and wrist joint injections are usually given for osteoarthritis symptoms. Each successive injection tends to have a shorter duration of effect. For example, thumb basal joint injections typically work well initially for six months at a time, but gradually by the fourth or fifth injection, the duration of effect drops to two months or less. If the injection is lasting less than two months, then the rationale for further injections expires. Surgery should be considered at that point depending on the patient’s pain symptoms. There is no upper limit for steroid injections in small joint arthritis so long as the patient is experiencing prolonged relief with each injection.

Elbow tendinopathy injections

Conditions such as Tennis and Golfer’s elbow are best treated with PRP (Platelet Rich Plasma) as a first line injection treatment rather than steroids, as there is a higher chance of permanent cure. In cases where steroids must be used, such as for diagnostic reasons in atypical cases, to achieve quick symptom relief, or where PRP injections don’t work, then a maximum of two steroid injections should be offered. Further injections are unlikely to cure the condition.

Shoulder and wrist capsulitis and bursal injections

For conditions like frozen shoulder, subacromial bursitis and wrist dorsal capsulitis; steroid injections are first line treatments. These injections should not be given on more than three occasions though to the same joint. Basic science studies show that further injections can have a deleterious effect on the surrounding tendons. If further injections are required, consider Hyaluronate.

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