Steroid injections are commonly used to treat a variety of inflammatory conditions of the upper extremity. Examples of these include trigger finger (stenosing tenosynovitis), de Quervain’s tendonitis, carpal tunnel syndrome, arthritis, tennis elbow (lateral epicondylitis), and rotator cuff tears (see Figure 1).
What is in a steroid injection?
Steroid injections typically contain a mixture of a synthetic cortisone and a local anesthetic such as lidocaine or bupivacaine. Cortisone is a steroid normally produced by the adrenal gland and is a powerful anti-inflammatory. There are several available synthetic preparations such as triamcinolone, betamethasone, and dexamethasone, and they are also commonly referred to by their trade names. They all have similar mechanisms although they vary in strength and duration of action (short versus long-acting). No single preparation has been found to be superior to others so the choice of medication is left up to the individual provider. These anti-inflammatory steroids are distinctly different from the anabolic steroids that have been abused by some athletes for body-building and performance enhancement. The local anesthetic dissolves the steroid and anesthetizes the area of the injection, diminishing discomfort during the procedure.
How does steroid injection work?
Steroid injections work by decreasing inflammation. Once the inflammation subsides, the associated pain usually improves as well.