Steroid / Hyaluronic Injections

How Do Steroid Injections Work?

 

Steroid injections work by preventing mRNA cells from producing cytokines—chemical messengers that drive inflammation. By blocking this inflammatory process, steroids help interrupt the cycle of pain and allow the affected tissue a chance to recover.

 

Benefits of Steroid Injections?

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The main benefit of a steroid injection is to reduce pain and improve your day-to-day function. This has been well-supported by decades of evidence-based literature confirming both safety and efficacy.For patients already engaging in rehabilitation, a steroid injection can create a valuable window of opportunity to progress, as pain is better managed in the short term.Recent research also shows that steroid injections can help reduce dependence on opioids and other oral pain medications. Evidence-Based Knee Injections for the Management of Arthritis | Pain Medicine | Oxford Academic

 

How Long Do Steroid Injections Last?

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The effectiveness of a steroid injection depends on the condition being treated, as well as factors such as age, health, and lifestyle.

Osteoarthritis 

For chronic conditions like osteoarthritis, global data suggests pain relief typically lasts around 3 months. The Magnitude and Duration of the Effect of Intra-articular Corticosteroid Injections on Pain Severity in Knee Osteoarthritis: A Systematic Review and Meta-Analysis - PubMed

Soft Tissue Injuries 

Soft tissue problems like shoulder impingement, De Quervain’s tenosynovitis, carpal tunnel syndrome, and plantar fasciitis often respond well to steroid injections. In many cases, a single injection provides lasting relief. However, symptoms can recur, and 1–2 repeat injections may be required for longer-term improvement.​

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What Are They?

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Hyaluronic acid injections have been used for several years to manage joint pain, particularly in osteoarthritis and following joint-related surgery. The injection contains components naturally found in healthy joint fluid, which help lubricate the joint and improve movement, potentially reducing pain and stiffness. More recently Ostenil has developed a product called "ostenil Tendon" which is used to treat tendon injuries such as tennis elbow, achilles tendonitis and patella tendonitis. 

 

Are They Available on the NHS?

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Currently, hyaluronic acid injections are not licensed for routine use on the NHS. This is mainly due to the high cost of the medication and clinical trials showing outcomes that are comparable to corticosteroid injections, which are significantly more affordable—often over 30 times cheaper.That said, there is some evidence suggesting hyaluronic acid may provide longer-lasting relief, especially at the six-month mark, when compared to steroids. However, the validity and strength of these studies remain under debate.

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What Are the Risks?

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One of the advantages of hyaluronic acid injections is their low risk of long-term side effects. Because the substance mimics the natural components of joint fluid, there is no strict limit on the number of injections you can receive over time—unlike corticosteroids, which require careful monitoring due to potential systemic effects.

Potential risks include:

• Infection (as with any injection procedure)

• injection soreness, which typically resolves within a few days Efficacy and safety of intraarticular hyaluronic acid and corticosteroid for knee osteoarthritis: A meta-analysis - PubMed​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​

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Considerations Risks​

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• Current NICE guidelines recommend:

No more than four steroid injections per year into a single body area

• A minimum 3-month interval between injections

• A maximum of 80 mg of steroid in that timeframe

This approach helps ensure both safety and the long-term effectiveness of treatment.

• Unlike steroid injections, Hyaluronic Acid (HA) injections carry no restrictions on how many you can have or how often they can be administered. This is because HA is a synthetic version of a natural substance already found in the body, primarily within the joints.

Side Effects & Risks

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Steroid injections are considered safe, with an extremely low incidence of adverse events.

Efficacy and safety of intraarticular hyaluronic acid and corticosteroid for knee osteoarthritis: A meta-analysis - PubMed

 

In my clinical experience, side effects are rare and generally mild. However, as with any procedure, some risks do exist.

Potential side effects include:

• Post-injection flare (temporary pain increase for 24–48 hours)

• Facial flushing Local fat tissue loss (lipoatrophy) or skin thinning

• Very low risk of infection (estimated at < 0.001%)  Local and Systemic Side Effects of Corticosteroid Injections for Musculoskeletal Indications - PubMed

Who Should Not Have a Steroid Injection​

Steroid injections should be avoided if:

• You’re currently unwell or on antibiotics for a recent infection

• You have an active infection at or near the injection site

• I also avoid administering steroid injections during pregnancy or breastfeeding, unless absolutely necessary. While corticosteroids are sometimes used in pregnancy for fetal lung development, their use for MSK conditions in these scenarios is not well studied.​​​​​​​​​​​​​​​​​​​​​​​​​​​​