Hand & Wrist Surgery
Healthy hands are essential to our everyday functioning and wellbeing – Just consider how few are the moments when you are not using your hands to do something. Yet usually we only recognise how invaluable our hands are once they are injured or in pain. Repetitive loading of the wrist, hands and/or fingers over the years may easily lead to premature wear of joints and tendons. Bear that in mind whenever you feel pain in your hands during demanding tasks – perhaps jobs can be done differently and hands nurtured for a change.
Steroid injections can be used to treat many problems in the arm and hand. The commonest are: carpal tunnel syndrome, tendonitis, trigger fingers, arthritis, tennis elbow and so on.
Cortisone is a steroid normally produced by your body and has a powerful anti-inflammatory effect on tissues. Corticosteroids tend to calm tissue irritation, inflammation and swelling and generally, ‘slow things down’. Injections are most commonly administered in an outpatient’s room, during the consultation.
Injected area is likely to become numb and pain free within the minutes of injection. Such early response is due to effect of the local anaesthetic commonly added to the mixture to make injection less uncomfortable. Patients should be careful if driving longer distances straight after the injection. This might be safe if only very limited area of the hand or finger has been treated. If sensation is altered in the larger area of the hand (which can be the case in certain situations), it might be safer to postpone administration of steroid for another occasion when somebody can escort you and drive instead.
In vast majority of cases, the therapeutic effects of injection become apparent after 3-5 days: pain eases off, triggering/clicking disappears, hand becomes stronger as you regain confidence and use it more comfortably. In general, improvement is likely to remain stable for several months. For some conditions, one injection solves the problem. For others, several injections may be required. There is no set rule as to how many injections a person can get.
In my practice, I rarely give more then 2 injections overall for non-arthritic conditions like carpal tunnel, tendonitis, trigger finger etc. If the second one fails to resolve symptoms completely, I prefer to suggest conversion to surgery. In case of arthritic conditions, I found injections purposeful as long as the symptoms are controlled well for at least 4-6 months with injection. There is no limit as to how many injections can be given overall, but their frequency should be limited to 2-3 per year.
Although we know well which conditions can be successfully treated with local administration of steroids, unfortunately it is impossible to predict with accuracy individual response to the injection. The same injection technique, the same corticosteroid used, the same amount given, etc. might resolve symptoms completely in one person, but fail another. Sometimes, second and/or third injection is more beneficial than the first one and vice versa.
All tissues (joints, tendons, nerves) treated with steroid injections ought be rested few weeks after the injection. This is necessary not only in order to augment positive effect of corticosteroids, but prevent possible damage of injected, weakened tissues with strenuous activities and/or loading.
- The commonest is so called “the flare“. This is a worsened pain felt for 2-3 days after the injection which represents an imminent response of diseased, irritated tissues to insult of injection and presence of steroids. It can be treated with ice and by resting the area injected.
- A rise in blood sugar level for diabetic patients for about five days
- Thinning of the skin (due to the atrophy of dermis – deep skin layer)
- “Lightening” (hypo-pigmentation) of the skin at injection site (more common in patients with
- Weakening of tendons, making them more likely to rupture
- Allergic reactions (rare)
- Infection (especially if the injection was given into a joint).
This page provides only basic and generic information, but full details and explanations are provided at the consultation.
Urgent concern after your surgery ?
Please ring the hospital where you have been operated on or my secretary and they will get in touch with me