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Corticosteroid Injections Carry Real Risks Including Tendon Rupture
Full Title
Adverse effects of extra-articular corticosteroid injections: a systematic review.
Summary
This systematic review examined 87 studies to estimate the occurrence and types of adverse effects after extra-articular (soft tissue) corticosteroid injections. The researchers categorized adverse events as major or minor. Major adverse events, which required intervention or did not resolve, included serious infections such as osteomyelitis and cellulitis, one fatal case of necrotizing fasciitis, tendon ruptures, skin atrophy, hypopigmentation, and local skin defects. The incidence of major adverse events ranged from 0 to 5.8% across studies. Minor adverse events, which were transient and did not require intervention, ranged from skin rash to flushing and disturbed menstrual patterns, with incidence as high as 81% in some studies. Increased pain or steroid flare after injection was reported in 19 studies. The review confirms that corticosteroid injections, while commonly used for pain relief, carry meaningful risks including tendon rupture, tissue atrophy, and serious infection. These findings support the recommendation that patients should be educated about these risks and encouraged to seek a second opinion before proceeding with corticosteroid injections, particularly when the injection is targeting tendon or ligament tissue that could be weakened by the steroid.