A joint injection is an injection of a steroid or other medication into a joint; any place two bones move against each other and are surrounded by a joint capsule.
The medication injected, usually a steroid, is meant to reduce the inflammation and/or swelling of tissue in the joint space. This may in turn reduce pain, and other symptoms caused by inflammation or irritation of the joint and surrounding structures.
The actual injection takes only a few minutes.
The injection typically consists of a local anesthetic and a steroid medication.
The procedure involves inserting a needle through skin and deeper tissues. So, there is some pain involved. However, we sometimes numb the skin and deeper tissues with a local anesthetic using a very thin needle before inserting the needle into the joint.
No. This procedure is done with a small gauge needle usually with or without any local anesthetic.
It is done with the patient in whatever position allows the best access into the joint. Shoulders, elbows, wrists, fingers and knees are often injected with the patient sitting. Hips, knees, ankles and toes are often injected with the patient lying down. The skin is cleaned with antiseptic solution and then the injection is carried out. A band-aid is usually applied.
Immediately after the injection, you may feel that your pain may be gone or quite less. This is due to the local anesthetic injected. This will last only for a few hours. Your pain will return and you may have a sore joint for a day or two. This is due to the mechanical process of needle insertion as well as initial irritation from the steroid itself. You should start noticing pain relief starting the 3rd to 5th day or so.
You may want to have a ride home. We advise the patients to take it easy for a day or so after the procedure. You may want to apply ice to the affected area. Perform the activities as tolerated by you.
Unless there are complications, you should be able to return to work the next day. The most common thing you may feel is sore joint.
The immediate effect is usually from the local anesthetic injected. This wears off in a few hours. The cortisone starts working in about 3 to 5 days and its effect can last for several days to a few months.
If the first injection does not relieve your symptoms in two to three weeks, you may be recommended to have one more injection. If you respond to the injections and still have residual pain, you may be recommended for further injections on an as needed basis, depending on the underlying condition of the joint.
In a six to twelve month period, we generally prefer not to perform more than three injections. This is because the medication injected is meant to last for several weeks to several months. If three injections have not helped you much, it is very unlikely that you will get any further benefit from an increasing number of injections. Also, giving more injections will increase the likelihood of side effects from the steroids. If the injections are not working, stronger consider may need to be given to orthopedic surgery.
It is sometimes difficult to predict if the injection will indeed help you or not. The patients who have recent onset of pain or milder pain may respond much better than the ones with a longstanding pain or severe pain.
Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects and possibility of complications. The most common side effect is pain – which is temporary. The other risks involve, infection, bleeding, worsening of symptoms etc. The other risks are related to the side effects of steroids: These include weight gain, increase in blood sugar (mainly in diabetics), water retention, suppression of body’s own natural production of cortisone etc. Fortunately, the serious side effects and complications are uncommon.
If you are allergic to any of the medications to be injected, if you have an active infection going on, or if you have poorly controlled diabetes or heart disease, you should not have a joint injection or at least consider postponing it if postponing would improve your overall medical condition.
Adapted: http://www.medcentral.org/body.cfm?id=348 July 25th 2010.