What is a joint injection?
A hypodermic needle is injected into the affected joint where it delivers a dose of any one of many anti-inflammatory agents, the most common of which are corticosteroids. The technique may be
used to also withdraw excess fluid from the joint.
Benefit in pain reduction and increased mobility is experienced within a few days if successful, and can last for months, but can be as short as 2-3 weeks of symptom relief.
- Corticosteroids: short-acting (eg hydrocortisone), intermediate-acting (eg methylprednisolone, triamcinolone), long-acting (eg dexamethasone).
- Local anaesthetics, eg lidocaine, bupivacaine.
- There is some evidence to suggest intra-articular hyaluronic acid is effective and gives more prolonged pain relief than intra-articular corticosteroids. However, it is not used by most UK
rheumatologists and is NOT recommended in current National Institute for Health and Clinical Excellence (NICE) guidance.
Indications for joint injections
- Joint conditions:
- Inflammatory arthritis, eg rheumatoid arthritis.
- Synovitis (swollen joints).
- Soft tissue conditions:
- Ganglion cysts
- Plantar Fasciitis (painful heel)
- Increased risk of causing joint infection, eg immunosupressed, broken skin over the injection point.
- Recent injury.
- Very unstable joint.
- Impending (scheduled within days) joint replacement surgery.
- Joint prosthesis.
- History of allergy to injectable constituents.
- Poorly controlled diabetes.
- Uncontrolled bleeding disorder.
- Those with diabetes: should closely monitor their blood glucose for two weeks following injection.
- Anticoagulated (Warfarin), bleeding disorder.
- Psychogenic pain, severe anxiety.
What will happen before the procedure?
- Your doctor will explain how to prepare for your procedure. He will discuss with you what will happen before, during and after the procedure, he will listen to your questions, concerns and
expectations and explain what alternatives to the procedure are available.
- In this way you will be able to give your informed consent for the procedure
What should I do after the procedure?
- Rest your joint for 1-2 days and avoid strenuous use for five days.
- Your joint may be painful for a while and you may need to use painkillers.
- Following injection, you might experience worsening symptoms during the first 24-48 hours (related to a possible steroid flare) which can be treated with ice and NSAIDs. If pain is severe or
increasing after 48 hours, you should seek medical advice.
- Consider possible other side-effects. You should seek help if systemic side-effects develop suggesting infection.
Side-effects and complications
Side effects are unwanted but usually temporary effects you may get after having the procedure.
Complications are when problems occur during or after the procedure.
- Infection (1/10,000). May need treatment with antibiotics.
- Post-injection flare of pain (2-5%); reduced incidence with rest for 24 hours.
- Skin discolouration or thinning; improves with time. More common with repeated injections.
- cartilage, tendons or nerves damage: more common with repeated injections (no more than three injections in each location per year).
- Flushing of skin.
- Temporary impairment of diabetic control.
- Changes in mood or insomnia.
- Changes in the menstrual cycle in women.
- Allergic reaction.
Dr Santini has performed hundreds of therapeutic joint injections.
He constantly keeps his skills updated and regularly attends workshops and courses on joint injections.
Information provided by www.patient.co.uk