Local Corticosteroid Injection in Hand Surgery: A Review of Molecular Mechanisms, Steroid Selection, and Clinical Outcomes
- 1Plastic and Reconstructive Surgery, Cooper Medical School of Rowan University, Camden, USA
- 2General Surgery, Cooper University Hospital, Camden, USA
- 3Plastic and Reconstructive Surgery, Cooper University Hospital, Camden, USA
Abstract
Local corticosteroid injection is among the most common procedures in hand surgery, yet the biologic rationale is often oversimplified as "reducing inflammation." This narrative review summarizes the molecular biology, pharmacology, and clinical outcomes reported in the literature on corticosteroid injection for common hand and wrist conditions. The aim of this review is to bridge basic glucocorticoid biology and clinical decision-making for hand surgeons. Glucocorticoids act through coordinated activities of both the genomic and non-genomic pathways, with varying time-related and downstream, tissue-specific effects on fibroblasts, tenocytes, and connective tissue. Steroid formulations have clinically meaningful differences with respect to particulate behavior, tissue residence, potency, solubility, and adverse effect profile. Evidence for the use of local corticosteroid injections is strongest for stenosing flexor tenosynovitis, de Quervain tenosynovitis, and mild-to-moderate carpal tunnel syndrome and more limited for limited or context-dependent for thumb carpometacarpal arthritis, Dupuytren nodules, and ganglion cysts. Adverse effects, including transient hyperglycemia, skin hypopigmentation, fat atrophy, tenocyte toxicity, chondrotoxicity concerns, and crystallization with certain anesthetic combinations, have identifiable biologic mechanisms that inform counseling and technique. Corticosteroid injection in the hand is not a generic anti-inflammatory event but a nuanced, tissue-specific pharmacologic intervention whose outcomes depend on steroid formulation, local anatomy, disease stage, dose, injection accuracy, and patient biology. A mechanistic framework can improve patient counseling, guide steroid selection, and identify questions for future comparative trials.
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BibTeX
@article{patel2026local,
title = {{Local Corticosteroid Injection in Hand Surgery: A Review of Molecular Mechanisms, Steroid Selection, and Clinical Outcomes}},
author = {Aneri U Patel and Leor Alkadaa and Michael J Franco},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.117128},
url = {https://europepmc.org/article/PMC/PMC13717673},
note = {CC BY},
}
RIS
TY - JOUR
TI - Local Corticosteroid Injection in Hand Surgery: A Review of Molecular Mechanisms, Steroid Selection, and Clinical Outcomes
AU - Aneri U Patel
AU - Leor Alkadaa
AU - Michael J Franco
PY - 2026
DA - 2026/09/29
JO - Cureus
DO - 10.7759/cureus.117128
UR - https://europepmc.org/article/PMC/PMC13717673
AB - Local corticosteroid injection is among the most common procedures in hand surgery, yet the biologic rationale is often oversimplified as "reducing inflammation." This narrative review summarizes the molecular biology, pharmacology, and clinical outcomes reported in the literature on corticosteroid injection for common hand and wrist conditions. The aim of this review is to bridge basic glucocorticoid biology and clinical decision-making for hand surgeons. Glucocorticoids act through coordinated activities of both the genomic and non-genomic pathways, with varying time-related and downstream, tissue-specific effects on fibroblasts, tenocytes, and connective tissue. Steroid formulations have clinically meaningful differences with respect to particulate behavior, tissue residence, potency, solubility, and adverse effect profile. Evidence for the use of local corticosteroid injections is strongest for stenosing flexor tenosynovitis, de Quervain tenosynovitis, and mild-to-moderate carpal tunnel syndrome and more limited for limited or context-dependent for thumb carpometacarpal arthritis, Dupuytren nodules, and ganglion cysts. Adverse effects, including transient hyperglycemia, skin hypopigmentation, fat atrophy, tenocyte toxicity, chondrotoxicity concerns, and crystallization with certain anesthetic combinations, have identifiable biologic mechanisms that inform counseling and technique. Corticosteroid injection in the hand is not a generic anti-inflammatory event but a nuanced, tissue-specific pharmacologic intervention whose outcomes depend on steroid formulation, local anatomy, disease stage, dose, injection accuracy, and patient biology. A mechanistic framework can improve patient counseling, guide steroid selection, and identify questions for future comparative trials.
SN - 2168-8184
ER -