Corticosteroid or hyaluronic acid placed inside a painful joint under image guidance.
Why does image guidance matter for a joint injection?
Guidance matters more than most patients think. Landmark-guided injections (placed by feel, without imaging) miss the target a real share of the time. Medication that is not in the joint cannot work.
What is a joint injection used for?
- Knee osteoarthritis
- Shoulder joint pain
- Hip joint pain
- Joint pain after a crash or fall
What to expect
- Ultrasound or fluoroscopic guidance.
- Takes 10 to 15 minutes.
- Soreness for a day or two is normal.
- Steroid can raise blood sugar for several days. Tell us if you are diabetic.
What are the risks of a joint injection?
Septic arthritis (joint infection) is the serious risk in any intra-articular injection. It is rare. But it is the reason for our strict germ-free technique. It is also why you must report pain that keeps rising with a fever the same day. A flare after the injection for one to two days is common, as the steroid crystals settle. We avoid repeated corticosteroid injections into the same joint at short intervals because of their effects on cartilage and tendons. If you have diabetes, expect higher blood sugar for several days.
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How do you know if a joint injection worked?
Guidance is what makes a negative result mean something. A landmark-guided injection that misses tells you nothing about whether the joint was the problem.
How long relief lasts is the useful signal. Weeks of relief argues for combining injection with strength work. Months of relief says to repeat it at sensible gaps. No relief from a confirmed intra-articular injection says the joint is not the source.
What should I do after a joint injection?
A driver is not usually needed. Rest the joint for the remainder of the day, then return to normal use — prolonged rest after a joint injection is counterproductive. You may have a flare of pain for one to two days as the medicine settles. If you have diabetes, check your blood sugar for several days. Report pain that keeps rising with a fever the same day.
How the procedure is actually done
An intra-articular injection puts medication inside the joint capsule itself. We use ultrasound for most joints in the arms and legs. We use fluoroscopy (live X-ray) for deeper ones such as the hip. Guidance matters because aim without it is poor for several joints. An injection that lands in the soft tissue around the joint gives no benefit and no usable answer.
Who it suits, and who it does not
It suits inflammatory or osteoarthritic joint pain when the joint has been shown to be the source. It also works as a test: relief confirms the joint is to blame. It is a poorer fit when the joint is loose and unstable, when infection is suspected, or when repeated steroid has already been given without lasting benefit.
Why the order matters here
Treatment aimed at the wrong part gives a poor result. Worse, it tells you nothing. That is why we confirm the target before we commit to anything long-lasting. It costs one visit, and it changes the odds a great deal. Some patients come in having had several unsuccessful injections elsewhere. They almost always had them without that confirming step.
Common questions
How often can I have these?
Not at short gaps in the same joint. Spacing matters. Injections work best alongside rehab, not in place of it.
Corticosteroid or hyaluronic acid?
Steroid works faster and suits an inflamed joint. Hyaluronic acid works more slowly and is used in some knees. The choice depends on the joint and what has been tried.
That is the subject of Osteoarthritis.
How long will it last?
Weeks to months. In many patients, it gets shorter with each repeat. Relief that keeps getting shorter is a signal to rethink, not to inject again.
Will it damage the joint?
Occasional guided injections are not thought to be harmful. We avoid frequent repeats, especially into a degenerative tendon nearby (one that is breaking down).
This is set out in Knee Pain.
What is the injection for joint pain called?
It is called an intra-articular injection. That means the medicine goes inside the joint capsule itself. We use either a corticosteroid or hyaluronic acid. It is placed under ultrasound for most joints, or fluoroscopy for deeper ones such as the hip. The guidance matters. Medicine that lands in the tissue around the joint gives no relief and no usable answer.
Is it normal to have more pain after a joint injection?
Yes. A flare of pain for one to two days is common as the steroid settles. Soreness for a day or two is normal. Rest the joint for the rest of that day, then go back to normal use. What is not normal is pain that keeps rising along with a fever the same day. Report that to us right away.
Does a steroid joint injection raise blood sugar?
It can. Steroid can raise blood sugar for several days after the injection. If you have diabetes, tell us before the procedure. Check your blood sugar closely for several days afterward. Hyaluronic acid is the other medicine we place in joints. The choice depends on the joint and what has been tried.
Related: small, tight joints such as the base of the thumb and the ankle need image guidance most of all. See thumb arthritis and ankle arthritis.
Sources
- Kolasinski SL et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis care & research, 2020. PubMed 31908149
- Bannuru RR et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and cartilage, 2019. PubMed 31278997
- Nchinda NN et al. Clinical Management of Olecranon Bursitis: A Review. The Journal of hand surgery, 2021. PubMed 33840568
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