A lump appearing after a steroid injection, such as a cortisone shot, is a common reaction that can cause concern for patients. These injections, which are suspensions of anti-inflammatory corticosteroid medication, are used to treat localized pain and swelling in joints and soft tissues. While they effectively reduce inflammation, the medication itself can sometimes trigger a localized reaction in the surrounding tissue, leading to a palpable lump or indentation. This reaction is generally benign, but understanding the type of lump and its expected duration is key to effective management.
Understanding the Types of Post-Injection Lumps
The lumps that form following a steroid injection usually fall into two distinct categories. The more common concern is localized fat atrophy, or lipoatrophy, which occurs when the steroid causes the fat cells beneath the skin to shrink. This results in a depression or pitting in the skin, sometimes perceived as a lump at the edges of the indentation.
Lipoatrophy is caused by the steroid’s potent anti-inflammatory action, which inhibits fibroblast growth and activates enzymes that break down subcutaneous fat. It often appears weeks to months after the injection and is more noticeable when the injection is administered close to the skin’s surface. While incidence varies, the resulting indentation can be distressing.
The second type of lump is a temporary, hard nodule caused by steroid crystal precipitation, often referred to as a “cortisone flare.” Corticosteroid medications are often administered in a suspension form, meaning tiny drug crystals are mixed in a solution for slow, prolonged release. If a localized deposit of these crystals is not quickly absorbed by the body, they can form a palpable, firm mass near the injection site.
This crystal deposit can cause a short-term increase in pain and swelling, known as a post-injection flare, which typically begins hours after the procedure and lasts for one to three days. A painful, spreading redness, warmth, or fever lasting more than 48 hours is not a normal reaction and may signal a serious issue like an infection or hematoma, which requires immediate medical evaluation.
Self-Care Strategies and Expected Resolution Timelines
Managing a post-injection lump involves a combination of patience and non-invasive measures, as many of these reactions resolve naturally over time. A lump caused by steroid crystal precipitation is typically transient, with the firm nodule softening and disappearing as the medication crystals are dissolved and absorbed by the body over several days to a few weeks. In contrast, lipoatrophy can take much longer to resolve, with spontaneous improvement sometimes occurring within six months to two years after the initial injection.
For managing the short-term discomfort of a crystal deposit, cold therapy should be used for the first 48 hours to minimize local inflammation and pain. Applying an ice pack wrapped in a towel for 15 to 20 minutes at a time can help calm the initial inflammatory flare.
After the initial 48-hour period, when the acute inflammation has subsided, heat application can be introduced. Applying a warm compress or a heating pad set to a low temperature helps increase local blood flow and lymphatic circulation, promoting the faster absorption and dissolution of remaining steroid crystals. Gentle, circular massage of the area can also be performed to help physically disperse the concentrated medication deposit.
For a lipoatrophy indentation, the goal of self-care is to encourage natural tissue regeneration and healing. Continuing the application of gentle heat and massage can stimulate circulation to the atrophied fat cells, potentially aiding in the natural process of volume restoration. Given the long timeline for spontaneous resolution of fat atrophy, consistent observation of the area is necessary to determine if the condition is persistent.
Clinical Options for Persistent Lumps
If a lump or indentation persists beyond the expected spontaneous resolution period—typically three to six months for fat atrophy—a consultation with a healthcare professional can explore clinical intervention options. For persistent lipoatrophy, several minimally invasive procedures can be performed to restore the lost volume.
Saline Injections
One of the simplest interventions is the injection of sterile normal saline directly into the atrophied area. The saline injection technique is believed to work by diluting and leaching the remaining steroid particles, which may be inhibiting fat cell recovery, allowing the tissue to rebound. Serial saline injections, often given weekly, have successfully restored contour in as little as four to eight weeks.
Dermal Fillers and Fat Grafting
Another effective option is the use of injectable dermal fillers, such as hyaluronic acid, which are typically used for cosmetic purposes but can be precisely placed beneath the skin to fill the depression caused by the fat loss. For a more permanent correction, small volume fat grafting can be performed. This involves harvesting a small amount of the patient’s own fat from a different body site, such as the abdomen, and transplanting it into the area of atrophy. This intervention provides a natural, living filler that can offer immediate and long-lasting restoration of the skin contour.
If the lump is persistent or represents a different issue, such as a localized fluid collection, the doctor may pursue other methods. Aspiration, which involves using a fine needle to withdraw the fluid or soft contents of the lump, may be an option if the deposit is liquified. In rare cases of a very hard, encapsulated deposit or if the lump exhibits signs of an abscess or a large hematoma, treatments involve antibiotics, drainage, or surgical removal.