Question:

I have had two steroid injections, one in my thumb and one in my shoulder. Both times they used an anesthetic. They are both injected at the same time in the same needle. I get a feeling that the anesthetic is causing it to feel tight and sore. Why is anesthetic injected with the steroid? Can it be done without the anesthetic? I would like to try it without it and see if I feel any better during the shots.

Answer:

Injections for neuromusculoskeletal problems often consist of a combination of steroid (“cortisone”) and local anesthetic (Lidocaine or Bupivicaine) mixed together in the same syringe.

The anesthetic will usually provide immediate improvement in pain (especially if Lidocaine is used, since its onset of action is quickest), and also serves to increase the total volume of fluid injected which may be beneficial if exposing a larger surface area of tissue to this mixture is desirable.

Injection of steroid without local anesthetic can certainly be performed. Although this would not have the above advantages, sometimes this is done:

• if a person experiences discomfort due to the chemical composition of the local anesthetic (for example, an uncomfortable burning sensation as it is injected), or
• when it is desirable to keep the volume of injected fluid to a minimum (such as when injecting a tight space such as the carpal tunnel or small joint of a finger), or
• when the numbness which follows injection of a local anesthetic is not necessary nor desirable (such as when injecting the carpal tunnel or a trigger finger).

Feel free to ask your physician, if it is determined you would benefit from another injection in the future, to inject just steroid without the local anesthetic.

For more information:

Go to the Sports Medicine health topic.