• A CSI can be helpful to ease pain and inflammation 
       • In most cases it should not be used a first-line treatment
       • Following CSI patients need to engage in treatment/rehab 
        programme (e.g. stretching/strengthening)
       • Patients from Primary Care should be managed locally for 
        injection without referral into secondary care (i.e. ortho) unless 
        for other specified reasons (e.g. further investigation or 
        surgical option)
        •  Referral should be based on:
         – Patients clinical need
         – Pain level
         – Functional restriction
        • Co-morbidities need to be taken into account as CSI may be 
         contra-indicated (further information on referral form)
        •  Err on side of caution 
         – The benefit of a CSI must outweigh the risk to patient
         How does Corticosteroid reduce 
               inflammation?
   • Corticosteroid mimics cortisol
    – Cortisol is a hormone produced in the 
     adrenal glands and has multiple effects 
     throughout the body
   • Cortisol lowers prostaglandin levels reducing 
    the interaction between T Cells and B Cells 
    which are involved in the immune response
   • Inflammatory response by tissues is reduced
                Considerations
    • Before referring for CSI consider the following:
      – Is an injection appropriate for this patient?
      – Is the patient happy to be referred for a CSI?
      – Has a face to face objective assessment been 
       undertaken?
      – Do you have a clear MSK diagnosis?
       •  e.g. do not refer Post-viral arthralgia, ‘non-
        specific painful shoulder’  
      – Has the patient undertaken appropriate 
       conservative management?
      – Does the patient agree to aftercare (i.e. initial 
       rest, engagement with rehab)?
                                             Indications
       Upper Limb                                           Lower Limb
       •  ACJ (OA and instability)                          •  Knee OA
       •  GHJ Capsulitis
       •  SAB                                               •  Plantar fasciitis 
       •  De Quervain’s tenosynovitis                           – Refer to podiatry ESP for US guidance
       •  CMC OA
       •  Trigger finger/thumb                              •  **Not indicated for GTPS/Achilles or 
                                                               patellar  tendinopathy** 
       •  **NOT indicated for tennis elbow**