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Self-care

After a Steroid Injection

What to expect in the first few days, when the relief kicks in, and the signs that should prompt a call.

What was injected

You received a small injection of a corticosteroid (a potent anti-inflammatory) mixed with a local anesthetic. The steroid works by calming the inflammation that is driving your pain, such as in a trigger finger pulley, an arthritic thumb CMC joint, a carpal tunnel, or a de Quervain's tendon compartment.

The first 24 hours

  • The area may feel numb for 2 to 6 hours because of the local anesthetic that was mixed into the injection. This is normal and wears off gradually.
  • It is reasonable to rest the hand during that time and avoid gripping or lifting anything heavy.
  • Ice the area for 15 to 20 minutes at a time several times during the first day to reduce soreness.
  • You can take acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) for soreness if it is safe for you to do so.

Day 1 to Day 3: the "steroid flare"

About one in five patients feels the injection area get more sore, not less sore, for 24 to 48 hours after the shot. This is called a steroid flare, and it happens because the steroid crystals briefly irritate the tissue before they dissolve and take effect. A flare is not a sign of infection or of a failed injection — it almost always settles within 2 to 3 days and is often followed by noticeable relief.

Ice, rest, and over-the-counter pain medication are the right treatment for a flare.

When the steroid starts to work

Most patients notice relief between day 3 and day 14 after the injection. Some feel it sooner, others take the full two weeks. If you are not feeling better by 2 weeks, call the office to discuss next steps — sometimes a single injection is not enough, and sometimes it means that the underlying problem needs a different treatment.

Common side effects

  • Soreness at the injection site for a few days (see "steroid flare" above).
  • Temporary blood sugar elevation. If you have diabetes, your blood sugar may run 50 to 100 points higher than usual for 2 to 5 days. Monitor it more closely during that window and contact your primary care provider or endocrinologist if you are not sure how to manage it.
  • Facial flushing. A warm, red flush of the face and upper chest for a few hours to a day or two after the injection. Harmless.
  • A sleepless night. Some patients feel "wired" the first night after a steroid injection and sleep poorly. This is short-lived.
  • Skin changes at the injection site. A small patch of lighter skin (hypopigmentation) or a small dimple of thinned fat (fat atrophy) can develop at the injection spot, especially with more superficial injections like the thumb base or the trigger finger pulley. When it happens, it is usually cosmetic only, is more visible in darker skin, and may or may not fade over months.

Activity

  • Use the hand for normal daily activities as tolerated, starting the day of the injection.
  • Avoid heavy gripping, heavy lifting, or strenuous sports for the first 48 hours so the steroid has a chance to stay where it was placed.
  • If a splint was part of your treatment plan (for example, a night splint for trigger finger or a thumb spica for CMC arthritis), continue wearing it as directed.
About repeat injections

A steroid injection can often be repeated once or twice if the first one helped but the relief was partial or wore off. Repeat injections into the same spot are usually spaced at least 3 months apart. There is no magic "lifetime limit," but when a problem needs an injection two or three times and keeps returning, the next conversation is usually about a more definitive treatment.

When to call the office sooner
  • Fever above 101°F
  • Redness, warmth, and increasing swelling at the injection site after the first 48 hours (rather than improving)
  • Pus or cloudy drainage from the injection site
  • Pain that is severe, throbbing, and getting worse after 3 days
  • New numbness, tingling, or weakness in the hand after the injection

Questions?

Call your office location for non-urgent questions:

See our office contact information for addresses and fax numbers.