Can steroid injections be used for tendonitis, and are there risks?
Steroid injections, also known as corticosteroid injections, are sometimes used to treat tendonitis when the pain is severe and has not responded to initial treatments like rest or physiotherapy. While they are a powerful tool for reducing localized inflammation, their use in tendons is approached with significant caution by healthcare professionals in the United Kingdom. Unlike bursitis, where steroids are injected into a fluid-filled sac, injecting around a tendon carries a specific set of risks related to the structural integrity of the tissue. Understanding the balance between rapid pain relief and long-term tendon health is essential for any patient considering this intervention within the NHS system.
What We’ll Discuss in This Article
- How corticosteroids reduce inflammation around an injured tendon.
- Why steroids are often injected near, rather than into, the tendon tissue.
- The specific risk of tendon weakening and potential rupture.
- Identifying the “steroid flare” and other short-term side effects.
- Why certain tendons, like the Achilles, are rarely injected with steroids.
- NHS-aligned protocols for managing the frequency of injections.
How steroid injections work for tendonitis
Corticosteroid injections work by delivering a concentrated dose of anti-inflammatory medication directly to the site of the irritated tendon. The steroid mimics the effects of cortisol, a hormone produced by the adrenal glands, to suppress the immune response and reduce swelling. This can provide rapid and significant pain relief, which is often helpful for breaking a cycle of chronic pain. According to NHS information on steroid injections, the goal is to settle the inflammation enough so that the patient can comfortably participate in the rehabilitation exercises necessary for long-term recovery.
The clinical approach: Peritendinous injections
In UK clinical practice, doctors rarely inject a steroid directly into the substance of a tendon. Instead, the medication is usually placed into the “peritendinous space,” which is the area immediately surrounding the tendon. This is done to deliver the anti-inflammatory benefits to the irritated outer lining (the sheath) while minimizing the direct exposure of the internal tendon fibres to the drug. Using ultrasound guidance is common for these procedures to ensure the needle is positioned accurately, avoiding the tendon’s core and reducing the risk of internal tissue damage.
Understanding the risk of tendon rupture
The most significant concern with using steroids for tendonitis is the potential for the medication to weaken the tendon’s structure. Corticosteroids can interfere with the way collagen fibres, the building blocks of tendons, remodel and repair themselves. Research and NICE clinical standards for tendinopathy highlight that repeated or inaccurately placed injections can lead to a significant decrease in the tendon’s tensile strength. In rare cases, this weakening can lead to a partial or complete tendon rupture, which is a serious injury that often requires surgical repair.
Why certain tendons are avoided
Because of the risk of rupture, some tendons are almost never treated with steroid injections in the United Kingdom. The Achilles tendon at the back of the heel and the patellar tendon at the front of the knee are subject to extremely high mechanical loads during walking and jumping. Because these tendons are under such intense tension, the risk of a steroid-induced rupture is considered too high. Instead, clinicians usually prioritize high-load eccentric strengthening programs for these areas. Steroid injections are more commonly considered for tendons that are not under the same level of constant weight-bearing stress, such as those in the shoulder or the wrist (De Quervain’s tenosynovitis).
Short-term side effects and the steroid flare
Following an injection, some patients experience a temporary increase in pain for twenty-four to forty-eight hours, known as a “steroid flare.” This happens because the steroid crystals can cause a brief inflammatory reaction before they begin to dissolve and work. Other localized risks include “fat atrophy,” where the fatty tissue under the skin thins out, or “skin depigmentation,” where the skin over the injection site becomes lighter in color. While these are usually cosmetic issues, they serve as a reminder that steroids are potent medications that affect all nearby tissues.
Frequency and long-term management
To protect tendon health, the NHS strictly limits the number of steroid injections a person can receive in the same area. Generally, you should have no more than three injections in one part of the body within a twelve-month period. If an initial injection does not provide relief that lasts for several months, it is usually a signal that further injections will be less effective and may increase the risk of tissue damage. At this stage, a GP or specialist will typically pivot to alternative treatments, such as shockwave therapy or a more intensive specialized physiotherapy program.
Conclusion
Steroid injections can be helpful for managing the intense pain of tendonitis, but they are used selectively due to the risk of weakening the tendon fibers. While they provide a valuable “window” of pain relief, they are not a permanent cure and must be followed by targeted exercises to strengthen the joint. Because of the risk of rupture in high-load tendons, your healthcare provider will carefully assess the site and severity of your injury before recommending this treatment. If you experience severe, sudden, or worsening symptoms, call 999 immediately.
Can a steroid injection cause my tendon to snap?
Can a steroid injection cause my tendon to snap? While the risk is very low for a single, accurately placed injection, repeated steroids can weaken the fibers and increase the risk of a rupture over time.
How long should I rest my arm after a tendon injection?
In the UK, it is standard advice to rest the affected joint for at least forty-eight hours to allow the medication to settle and prevent a flare.
Will I see a difference in my skin after the injection?
Some people notice a small white patch or a slight indentation where the fat has thinned, particularly if the injection was near the surface of the skin.
Why did my doctor refuse an injection for my Achilles tendon?
The Achilles takes a lot of weight when you walk; injecting it with steroids significantly increases the risk of it snapping, so it is usually avoided.
Can I have a steroid injection if I have a small tear in the tendon?
A clinician will be very cautious with an existing tear, as the steroid could potentially prevent the tear from healing or make it larger.
How many steroid injections can I have in total?
Most UK guidelines recommend no more than three in one year at the same site to prevent long-term damage to the tissues and nearby bone.
Does the injection hurt more than the tendonitis itself?
The needle prick is brief, but the “steroid flare” can make the area feel quite sore for a day or two before the pain relief begins to work.
Authority Snapshot
This article outlines the clinical use and potential risks associated with corticosteroid treatments for tendon injuries. It has been written by the MyPatientAdvice Medical Writing/Research Team and reviewed by Dr. Rebecca Fernandez to ensure clinical accuracy. The information provided is strictly aligned with the current NHS and NICE protocols for the management of musculoskeletal conditions and the safe administration of joint injections in the United Kingdom.
