What are the Side Effects of Steroid Injections?

October 9, 2025 •

2 min read

According to the American Academy of Orthopaedic Surgeons, intra-articular steroid injections are a common treatment for painful joint conditions like arthritis. So, what are the side effects of steroid injections and what can you expect after receiving one?

Quick Summary

Steroid injections deliver powerful anti-inflammatory medication locally, but can cause side effects ranging from common, temporary issues like injection site pain and flushing to rare, serious complications such as infection, tendon rupture, and bone damage.

Key Points

Local vs. Systemic Effects: Side effects can be local (at the injection site, like pain or skin changes) or systemic (affecting the whole body, like flushing or blood sugar spikes).
Post-Injection Flare: A temporary increase in pain and swelling can occur within 24 hours of the injection due to the steroid crystals.
Diabetic Alert: Patients with diabetes must closely monitor their blood glucose levels for several days, as steroid injections can cause temporary hyperglycemia.
Tissue Damage Risk: Repeated injections in the same area carry a risk of weakening soft tissues like tendons, potentially leading to rupture.
Serious but Rare Risks: Though rare, complications can include joint infection, avascular necrosis, and in spinal injections, serious neurological events.
Informed Decision-Making: A comprehensive discussion with a healthcare provider is essential to weigh the benefits of pain relief against the risks, considering personal health factors.

Understanding Steroid Injections

Steroid injections, also known as corticosteroid or cortisone shots, are commonly used to reduce inflammation and pain in specific areas of the body. These are not the same as anabolic steroids used for muscle building, but rather anti-inflammatory drugs similar to cortisol. They treat localized conditions like arthritis, bursitis, and tendinitis. Even though they target a specific area, these injections can still cause various effects.

Common Short-Term Side Effects

Most individuals experience mild, temporary side effects that usually disappear within a few days. These include post-injection flare (increased pain), facial flushing, increased blood sugar (especially for diabetics), insomnia, and temporary skin/soft tissue changes. Icing may help with post-injection pain.

Potential Long-Term and Serious Complications

More serious side effects are less common but can occur, particularly with repeated injections. Risks include damage to soft tissue like tendons, osteoporosis, cartilage damage, avascular necrosis, adrenal suppression, and rare infection. Doctors often limit injections in a single joint per year.

Comparison of Local vs. Systemic Side Effects


Feature	Local Side Effects	Systemic Side Effects
Mechanism	Occur at or near the injection site due to direct delivery of the drug.	Result from the steroid being absorbed into the bloodstream and affecting the body's systems.
Common Examples	Pain flare, bruising, skin discoloration, skin thinning.	Facial flushing, insomnia, temporary blood sugar increases, mood swings.
Severe Examples	Tendon rupture, local infection, bone damage.	Adrenal suppression, osteoporosis, avascular necrosis, rare neurological events.
Frequency	More common, especially temporary pain flares.	Less common with localized injections compared to oral steroids, but still possible.

Important Considerations and Rare Occurrences

Discussing risks with a healthcare provider is crucial. Special populations like diabetics (risk of hyperglycemia), athletes (tendon weakening risk), and those with planned surgery (infection risk) require careful consideration. Extremely rare complications, particularly with spinal injections, include neurological events (paralysis, stroke, vision loss) and Tachon syndrome.

Conclusion

Steroid injections offer effective pain relief and reduce inflammation. Patients should be aware of common temporary effects and less frequent serious risks. Risk is influenced by dose, frequency, and injection site. A thorough discussion with a healthcare provider is essential to determine if a steroid injection is appropriate.

For further information, the Mayo Clinic provides detailed insights into corticosteroid risks and benefits. {Link: Mayo Clinic https://www.mayoclinic.org/tests-procedures/cortisone-shots/in-depth/steroids/art-20045692}

Frequently Asked Questions

Most temporary side effects, such as facial flushing or injection site pain, resolve within a few days. The pain-relieving effect can last for several weeks to months.

Yes, a cortisone shot can temporarily increase your blood sugar levels. Patients with diabetes should monitor their blood sugar more frequently for about five days after the injection.

Yes, a temporary increase in pain, known as a 'steroid flare,' is a common side effect. It typically subsides within 24 to 48 hours.

Most healthcare providers recommend limiting injections to three or four per year in any single joint to minimize the risk of cartilage damage or soft tissue weakening.

Long-term risks, more often associated with frequent, repeated use in the same area, can include damage to cartilage, tendon weakening or rupture, bone density loss (osteoporosis), and avascular necrosis.

While rare, nerve damage is a possible, though serious, complication, especially if the injection is administered improperly near a nerve.

You should contact your healthcare provider immediately if you notice signs of infection, such as increasing pain, redness, or swelling at the injection site that lasts more than 48 hours, especially if accompanied by fever.