The Risks of performing an Intramuscular Injection – Read this, Important !

Intramuscular injection i.e. injection of Anabolic Steroids, Testosterone and other doping substances always involves risks.

Injecting any drug is potentially very dangerous. 

Injecting Androgenic and Anabolic Steroids is potentially very dangerous. 

If you experience any adverse event re your injecting I recommend you consult your Medical Provider. Remember that a Health Professional will only be able to help you properly if you are honest about your steroid use. Don’t just hope that problems will get better on their own—they’re just as likely to get a lot worse !

There are some issues that specific to “our” class of compound however most apply to all substances that make use of Intramuscular Injection as the means of Administration. 

* Sharing injection equipment puts you at risk of serious infections such as HIV or Hepatitis C. Never share injection equipment or multi-use vials with anyone ever. 

Injecting Problems

Nerve injection injury (NII) 

Nerve injection injury (NII) is a common complication following intramuscular injection and the sciatic nerve is the most frequently affected nerve. Sciatic nerve injection injury (SNII) has been recognized for many years: ‘sciatic neuritis due to injection’ was first reported in 1882 and sciatic nerve injuries were reported after quinine injections as early as 1920’s. Hitting a nerve can cause permanent damage and even paralysis. 

How do you know if you have inflicted a Nerve Injection Injury on yourself ?

If you feel a severe pain, like an electric shock, when the needle goes in then it is likely you have hit a nerve. 

The glute and delts serve as the most predominant targets of IM injections within our tribe, with the Glute being the most common site of administration. It is unsurprising therefore that the sciatic nerve is the most commonly affected nerve.

The reported cases of upper limb nerve injury followed by needle procedure such as intramuscular injection are rare. However, it should not be overlooked, because neurological injury may cause not only minor transient pain but also severe sensory disturbance, hand deformity and motor dysfunction with poor recovery.  

Causation of Nerve Injection Injury

Several mechanisms are associated with injection-related nerve injury

Direct needle trauma
Toxic effects of injected agents on nerve fibers and surrounding tissues
Nerve compression due to hematoma or edema formation
and so on. 

Of these factors, direct needle trauma is the most frequent factor. Therefore, sufficient knowledge of anatomy, understanding of the procedure to be performed, and adept skills in needle placement are essential to avoid these complications 

Injuries attributable to anatomic variation ( that is differences between individuals ) are exceedingly rare. Subsequently, the most important factor in preventing Nerve Injection Injury is the knowledge and experience of the individual placing the needle

The length of the needle, the angle of the needle and the position of the patient during injection are other major factors in NII 

Takeway ? 

It is essential that you learn good Intramuscular Injection Technique 

Presentation of Nerve Injection Injury

If the injury is caused directly by the needle tip, you will typically experience immediate, sharp, and electric–like pain over the point of administration at the time of injection. 

Nearly 90% of patients with SNII have an immediate onset of symptoms the remaining 10% of patients have a delayed onset of symptoms that appears minutes to hours after the injection. 

What to do if you hit a Nerve ? 

If you notice any experience of abnormal pain or paresthesia ( meaning an abnormal sensation, typically tingling or pricking (“pins and needles”), caused chiefly by pressure on or damage to peripheral nerves during the needle procedures, you should be alert to the possibility of nerve injury and should withdraw the needle immediately. Do not continue to admin at that location, exchange the needle and try another location. 

The neurological presentation that will follow may range from minor transient pain to severe sensory disturbance and motor loss with poor recovery. 

Careful monitoring of the injection site for several hours is required for early detection of nerve injury. 

Management of Nerve Injection Injury 

Management of nerve injection injury includes drug treatment of pain, physiotherapy, use of assistive devices and surgical exploration. 

Early recognition of nerve injection injury and appropriate management are crucial in order to reduce neurological deficit and to maximize recovery. 

The treatment of Nerve Injection Injury is a topic of some debate in the literature and clinical practice. The vast majority of injection nerve injuries will heal on their own with a moderate time frame perhaps supported by a non-opioid analgesic like Ibuprofen. 

The current consensus is that if the symptoms are mild, that is, complaints of pain or numbness without loss of motor function, the treatment team should provide at least 3-6 months of conservative therapy before subjecting the patient to more invasive techniques. 

Muscle Damage

Repeated injections into the same muscle can cause damage and scarring which may affect muscle function. Further injections may be painful and badly absorbed. Remember to switch or rotate the place you inject, each time you inject.

There are 4 recommended site locations for IM injections and 2 sides of the body, these were discussed in the previous chapter.  I recommend you consider them all on a ” rotational basis”  

Used and too-short needles will damage the tissues – see the Chapter of Needle Selection – Gauge and Length 

Internal Bleeding (haemorrhage)

Accidentally puncturing a blood vessel when you inject can cause bleeding inside the muscle (a haemorrhage) which, at the least, will affect your training performance and cause stiffness and pain. 

Infection ( Redness and Swelling ) 

Non-sterile equipment, contaminated product or poor hygiene practices can lead to infections at the injection site typically identified in the first instance by redness and swelling. If the injection site becomes hot or red or starts to weep fluid, then you should stop injecting there and seek medical attention before the problem gets worse.

Many of the anabolic steroids that are bought on the black market from underground labs contain a different substance or substances, or a different dose, than that which is described on the label. 

Black market or UGL products may also contain impurities developed in the production stage due to proper lack of hygiene in illegal drug factories, in the case of ” home brewing * ” read this as “someone’s kitchen table”.  

Illegally produced products can cause many health problems because the user has no idea what they actually contain. The microbes in injection substances, injection equipment or already-existing on the skin, can enter the body causing very serious infections.  Use of illegal drugs and doping substances purchased off the Internet or the black market can be dangerous because their true composition cannot be known without laboratory examinations.

* I am not a fan of ” Home Brewing” for our tribe, principally because this practice exponentially lowers the quality control profile.  High-quality manufacturers will perform batch-based impurity testing on all incoming products used in Manufacture and again before shipment along with manufacture in cleanroom environments.  The very nature of Home Brewing prohibits these measures being in place due to the costs involved. Even those with the ” best intention” can not produce ” high quality product” in a Home Brew environment.   

Injected substance impurities, dirty injecting equipment and insufficient cleaning of the skin may easily lead to infections around the injection location when the bacteria and other microbes get into the body. 

Injection-related bacterial infection may cause cellulitis (subcutaneous fatty tissue inflammation) or abscesses, for example, subcutaneously or intramuscularly. Symptoms of cellulitis are pain and soreness around the injection site, redness and induration on the injection site, and fever. Abscess symptoms are similar: it may be surrounded by redness, warmth, swelling and pain.  A large abscess can bring on high fever. 

If left untreated, abscesses and fat tissue inflammation can be dangerous so it’s worthwhile consulting a doctor. If necessary, the doctor empties the abscess and treats infections with antibiotics.

Management of Infection from Intramuscular Injection 

Abscesses should not be squeezed by the person concerned.  

If the abscess burst under the skin and the bacteria spread through the blood circulation into the body, it can result in a life-threatening blood infection i.e. sepsis. Sepsis symptoms include general malaise, fever, chills, nausea, vomiting, diarrhea, tachypnea, and confusion. Sometimes the body will get small haematomas.  Sepsis always requires hospitalization.  

In addition to sepsis, the spread of bacteria, if left untreated, may result in a rare but life-threatening soft tissue inflammation which is necrotizing i.e. leads to necrosis.  Bacteria causes a rapidly progressive muscle fascia, fatty or muscle tissue destruction which may result in amputation. 

Spread of bacteria in the body can also cause endocarditis, infections of the inner heart membrane and heart valves which, if untreated, can lead to death.

After an injection, if you develop a high fever, if your general physical condition worsens, if you feel severe pain or experience other unforeseen health problems, consult your doctor. 

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