Joint Injections


A joint is a place where two bones move against each other and is surrounded by a joint capsule. A joint injection is an injection of a steroid and/or other medication into a joint. This procedure is most often used Knee painin the knee joint, but can be done for the joints of the shoulder, hip, ankle, and elbow.

Why are joint injections done?

A common cause of joint pain is inflammation of the joint lining, which is called synovitis. Directly injecting a corticosteroid and/or local anesthetic into joint space, or the soft tissue next to the joint (bursa), will reduce inflammation and offer pain relief. Because there is less pain, the patient can benefit from physical therapy.

Sometimes, the cause of joint pain is difficult to diagnose, so if the pain is not related to joint inflammation, an injection will not improve your symptoms. While this can be disappointing, it provides helpful information for your doctor because it means he/she should consider another cause of joint pain.

Interestingly, we know that degenerative arthritis involves a significant amount of inflammation. The reason is that over 75% of degenerative joints receive significant pain relief after a steroid injection. So we know that’s the case.

How do I prepare for a joint injection?

Prior to the scheduled appointment day, you can eat and drink as usual. You do not need to do anything special to prepare for the joint injection. The main thing to remember is to wear comfortable clothing that allow easy access to the joint being treated.

Be sure to bring with you any previous diagnostic imaging tests, such as x-rays, computed tomography (CT) scans), and magnetic resonance imaging (MRI) scans. In addition, notify the medical staff if you are allergic to any medications.

What happens during the joint injection procedure?

The joint injection is often done using ultrasound of fluoroscopic guidance, so the doctor can make sureknee injection the medication goes into the joint or bursa correctly. For a hip this is often case. For a knee, though, it’s typically not necessary.

The precise technique used depends on the joint being injected and the doctor who performs the procedure.  The skin is cleansed with an antiseptic solution, and the needle is gently inserted into the joint or bursa. It may be necessary for the doctor to remove some fluid from the joint for analysis (arthrocentesis) before injecting the medication. The entire procedure typically takes between 10 and 20 minutes to perform.

What are the after effects of a joint injection?

After the joint injection, you may experience some soreness in and around the joint. However, the pain and stiffness will improve due to the effects of the anesthetic and steroid medication.

Once the anesthetic wears off (after 1 to 8 hours), you will likely have pain, which could last for around 2 days after the injection. The steroid medication starts to reduce inflammation and pain between 2 to 5 days after the procedure, which will allow for improved joint function and mobility.

What are the risks and complications of a joint injection?

As with any minimally invasive procedure, there are a few risks and complications associated with the joint injection. However, this procedure is generally safe and effective when performed by a skilled practitioner.

The complications include infection, aggravation of pain (due to irritation of the joint lining by the steroid solution crystals), allergic reaction to the medications, and damage to the soft tissues at the injection site, which includes weakening and atrophy of the skin and fat tissue, as well as rupture of one of the joint tendons.

How many joint injections can I have?

Many patients enjoy adequate pain relief following the joint injection for 2 to 5 months. Should the pain return, the doctor can perform another injection. The exact risk of multiple injections is not known, buHip_Injectiont most doctors will not perform more than 3 or 4 joint injections to the same joint in a 12 month time span.

Do joint injections work?

According to a major Cochrane review, intra-articular corticosteroid injections for the treatment of knee OA are effective. Research shows evidence at 2-3 weeks post-injection that steroid is more effective than placebo for pain reduction.

Also, the effects can last for up to 24 weeks. In addition, a recent controlled trial involving hip OA showed that patients who receive hip joint injections of steroids had significant improvement in pain and function at a 3-month follow-up.

Steroid injections may be repeated every few months as needed.

Resources

Bellamy N, Campbell J, Robinson V et al. Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev 2006; 19: CD005328.

Lambert RGW, Hutchings EJ, Grace MGA, Jhangri GS, Conner-Spady B, Maksymowych WP. Steroid injection for osteoarthritis of the hip. A randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2007;56(7):2278–87. doi: 10.1002/art.22739.