#treatment - Hand & wrist

Steroid injection in the hand and wrist

Steroid injections

I commonly perform injections of steroid into tendon sheaths and joints in the hand, wrist and elbow.

Some areas are difficult to access without ultrasound guidance and occasionally a referral to ultrasound is necessary. However the vast majority of tendons and joints in the elbow, hand and wrist can be felt clearly under the skin and are easily accessed in the clinic.

I typically inject 40 mg of DepoMedrone and 0.25% Bupivacaine. I use about 1 ml of Bupivacaine which normally causes local numbness for about 2 hours.

I do not insert the local anaesthetic before the steroid because this is just as painful as doing both at once.

These injections are often diagnostic as well as therapeutic and if no relief of pain is forthcoming then it is likely that the pain is not coming from that particular area.

I warn all my patients about steroid flare. This is a well recognised complication of steroid injections. The majority of patients will have some pain for 24 to 48 hours after the injection. This typically starts the next day after the injection. There is sometimes an area of redness or swelling in association with this. Standard painkillers, elevation and application of ices usually all that is required. Some patients find it difficult to work under the circumstances and taking a day off is perfectly reasonable.

Relief of symptoms usually comes on at 2 to 7 days. It can occasionally take slightly longer. The DepoMedrone is usually present within the soft tissues for 6 to 8 weeks. Symptoms may recur when the steroid has all disappeared.

The majority of patients who experience symptom relief most conditions will not need a 2nd injection but subsequent injections are occasionally required.

We discourage patients from having more than 2 or 3 injections into one area and the minimum interval is usually about 3 months. The main problem with more frequent injections is one of skin thinning, loss of pigmentation or weakening of tendons resulting in tendon rupture. Infection is a very rare complication that has been reported. It is no more than a few in 1000 cases.

I perform these injections across the desk in the consulting room. It normally takes no more than a few seconds after preparing the skin with antiseptic. It is normally a little more painful than having a blood test and some patients feel a little faint and are asked to lie down.

For most conditions in the hand and wrist 80% of patients will not require a further injection.

Mark Phillips