Local Corticosteroid Injection in Hand Surgery: A Review of Molecular Mechanisms, Steroid Selection, and Clinical Outcomes

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.