Contraindications and Potential Side Effects of Injections

Musculoskeletal injections are generally considered safe and beneficial procedures when performed according to the indications and avoiding cases with absolute contraindications such as known hypersensitivity to any component of the injection, cellulitis or broken skin, unstable coagulopathy, and intra-articular or osteochondral fractures. However, it is important to acknowledge that complications have been reported in the literature also without the presence of contraindications. These complications can be classified into three groups. The first group comprises joint-related effects, such as pain flare, infection, pseudoseptic arthritis, and steroid arthropathy. The second group encompasses effects on surrounding tissues, including pericapsular calcification, tendon rupture, and skin alterations. The third group includes systemic effects resulting from the local injections. The absorption of corticosteroids following a local injection varies, and, in most cases, especially with accurate intra-articular administration, the systemic absorption of locally injected musculoskeletal corticosteroids is minimal. However, some potential systemic effects include Cushing syndrome and hyperglycemia, which can occur in both diabetic and nondiabetic patients. Facial flushing is a more common and self-limited consequence. Rarely, anaphylaxis or neuropsychiatric changes may occur.