The Hand Therapy Blog

How do Corticosteroids work?

The steroids that we most frequently use for hand and upper limb conditions at Hand Therapy Servicves NI are triamcinolone and methylprednisolone. These agents mimic the body’s natural hormones to modify the inflammatory process and dampen immune responses in local tissues. This anti-inflammatory action is what helps alleviate symptoms that are often driven by inflammation around tendons, pulleys and nerve sheaths.

Corticosteroids do not “heal” tissue directly, but by reducing inflammation they create a more favourable environment for rehabilitation, allowing patients to engage more effectively in therapeutic exercise, splinting and functional retraining. Combined with hand therapy, steroid injections can accelerate recovery, decrease pain-related guarding, and improve mobility, especially in conditions where pain limits use of the hand.

At Hand Therapy Services NI, we frequently treat the following conditions using steroid injections as part of a wider hand therapy treatment plan.

Trigger Finger/Trigger Thumb: A Proven Option for Pain and Locking

Trigger finger (stenosing tenosynovitis) occurs when the flexor tendons or their pulleys become inflamed, causing pain, catching or locking of the involved digit. Corticosteroid injections are one of the main non-surgical treatments offered. Evidence suggests that they significantly improve symptoms compared with placebo injections, with roughly three times higher rates of treatment success at short-term follow-up.

Studies and reviews have shown that 57% to 81% of patients treated with corticosteroid injections experience meaningful relief, with many achieving long-term remission of symptoms without surgery. In long-term follow-up, many people continue to benefit and even repeat injections can yield extended relief in a substantial proportion of cases.

At Hand Therapy Services NI, we use steroid injections for trigger finger and trigger thumb along with education, bespoke exercises and splinting, reducing pain and mechanical catching so that the patient can move the finger comfortably getting back to everyday activities much quicker.

Symptom Relief for Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) results from compression of the median nerve in the wrist, leading to numbness, tingling, weakness and pain in the hand. Local corticosteroid injections into the carpal tunnel are intended to reduce inflammation within the confined space and relieve pressure on the nerve. Randomized controlled trials show that corticosteroid injections provide greater clinical improvement in symptoms at one month compared with placebo, and are more effective than systemic oral steroids up to three months post-treatment. While long-term benefit beyond a few months is less well established, many people experience meaningful relief that can delay or even prevent the need for surgery in the short term.

At our Belfast and Hillsborough Clinics, we use steroid injections, hand therapy and occupational therapy together: the injection reduces pain and nerve irritation, while therapy focuses on nerve gliding exercises, ergonomic modifications, activity modification and strengthening, all aimed at sustained functional improvement.

Pain Relief for De Quervain’s Tenosynovitis

De Quervain’s tenosynovitis affects the tendons on the thumb side of the wrist, causing pain and difficulty gripping or bending the thumb. Evidence from controlled trials, shows that steroid injections outperform splinting alone, with complete pain relief observed in all participants of one study shortly after treatment. In practice, combining steroid injections with thumb splints and guided exercises helps reduce pain and tendon sheath inflammation so patients can resume gentle motion sooner. Our hand therapists also teach activity modification and strengthening once pain is under control, enhancing long-term recovery.

Lateral Epicondylitis: Short-Term Help, Longer-Term Rehab

Lateral epicondylitis (tennis elbow) is an overuse condition of the extensor tendons at the lateral elbow. Reviews indicate that corticosteroid injections can provide effective short-term pain relief and improvement in grip strength, often superior to conservative treatments in the early weeks. However, muscle and tendon-focused therapies tend to outperform injections in intermediate and long-term follow-up, highlighting that steroid shots are best used as part of a multi-modal plan that includes progressive loading, manual therapy and ergonomic advice.

Pain Relief for CMC joint/ base of thumb arthritis

Corticosteroid injections can be used for basal thumb (CMC) osteoarthritis to reduce pain and improve function, particularly in the short term. Research shows that many patients experience pain relief and improved hand use for 1–3 months, though results vary between individuals. Studies and reviews highlight that while injections can be helpful, benefits may be temporary and should be combined with hand therapy and activity modification for best outcomes.

At Hand Therapy Services NI, we combine practical advise to enhance daily function, hands on manual therapy, exercise and if required, steroid injection therapy to help patients relieve pain and optimise their ability to perform every day tasks.

How Injections and Hand Therapy Work Together

Corticosteroid injections should never be viewed as a standalone “fix,” but rather as a tool within a comprehensive rehabilitation strategy. Their key benefits include:

• Rapid reduction of inflammation and pain, helping break the cycle of pain-avoidance and disuse.

•Improved mobility by reducing stiffness and allowing more active participation in therapeutic exercises.

• Enhanced tolerance for functional tasks, which is the cornerstone of our occupation based hand therapy programs.

By reducing the inflammatory response and associated pain, steroid injections enable the therapist and patient to focus on restoring strength, coordination, mobility, and activity tolerance for lasting recovery.

Conclusion

Corticosteroid injections play an important role in hand therapy for a range of conditions. Research supports their short-term effectiveness for trigger finger, carpal tunnel syndrome, De Quervain’s tenosynovitis and lateral epicondylitis, particularly in reducing pain and enabling improved function. When used strategically and combined with targeted hand therapy interventions, including splinting, exercise, education and activity modification, they can help patients return to comfortable, functional use of their hands more quickly and with less pain.

In our clinic, Occupational Therapists administer corticosteroid injections as part of an extended scope of practice. This role requires specialist Master’s-level training and formal competency assessment to ensure safe, evidence-based care. Our therapists completed advanced injection training in London and regularly undertake refresher training with the Royal College of Surgeons in Ireland (RCSI) in Dublin, ensuring we remain fully competent and up to date in delivering the safest possible treatment for our patients.

Attending our specialist hand therapy clinic offers clear advantages. Our therapists are trained to deliver both comprehensive hand therapy and corticosteroid injection therapy when appropriate, allowing for faster access to treatment, excellent continuity of care, and a truly integrated approach. This seamless pathway supports quicker pain relief, more efficient rehabilitation, and improved functional outcomes.

If you would like more information or advice on the use of steroid injections in your hand therapy journey, please get in touch.

References

Trigger Finger

1. Peters-Veluthamaningal C, van der Windt DAWM, Winters JC, Meyboom-de Jong B. Corticosteroid injection for trigger finger in adults. Cochrane Database of Systematic Reviews 2022, Issue 3. Art. No.: CD005617. DOI: 10.1002/14651858.CD005617.pub2 — evidence on efficacy of corticosteroid injection vs placebo/lidocaine.
2. Systematic review of corticosteroid type and outcomes in trigger finger treatment (methylprednisolone vs triamcinolone). Comparative effectiveness of corticosteroid injections for trigger finger. PubMed review.
3. Lambert MA, Morton RJ, Sloan JP. Controlled study of local steroid injection in trigger finger and thumb — example RCT within Cochrane review.

Carpal Tunnel Syndrome

4. Marshall SC, Tardif G, Ashworth NL. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database of Systematic Reviews 2007, Issue 2. — short-term symptom relief vs placebo/oral steroids.
5. RCT evidence of carpal tunnel improvements after local corticosteroid injection; comparison with systemic steroid and other treatments (PubMed).

De Quervain’s Tenosynovitis

6. Corticosteroid injection for de Quervain’s tenosynovitis. PubMed trial — methylprednisolone + bupivacaine vs thumb spica splint; full pain relief observed in small RCT.

Lateral Epicondylitis (Tennis Elbow)

7. Corticosteroid injections for lateral epicondylitis: a systematic review. PubMed. — evidence of short-term benefit and limited longer-term effectiveness. General/Injections Across Conditions
8. Efficacy analysis of corticosteroid injection doses (high vs low triamcinolone) across several hand conditions including trigger finger, carpal tunnel, and de Quervain’s. PubMed contemporary study.

Base of Thumb Arthritis/ Osteoarthritis Murray E, et al. Injection therapies for base of thumb osteoarthritis: a systematic review Day CS, et al. Intra-articular corticosteroid injection for trapeziometacarpal osteoarthritis: a randomized controlled trial Rizzo M, et al. Trapeziometacarpal osteoarthritis: corticosteroid injections and non-surgical management