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by Kerr SJ

Joint Injection

(Steroid Joint Injection; Cortisone Joint Injection; Corticosteroid Joint Injection; Cortisone Shot)

Definition

Joint injections are medicines injected into a joint. They are given to reduce pain and swelling in a joint. The medicine is often a combination of corticosteroids and local anesthetic (numbing medicine). Injections may relieve pain for several weeks or months.
This treatment is most often used in joints like the hips, knees, and shoulders.

Reasons for Procedure

Your doctor may recommend a joint injection if you have pain and/or swelling from:
Rheumatoid Arthritis
rheumatoid arthritis
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Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
  • Worsening pain
  • Damage to skin and tissue
  • Worsening of other conditions (eg, diabetes)
  • Tendon rupture
  • Hypopigmentation (loss of skin color)
  • Joint infection (small risk)
Another possible complication is steroid flare. This is an increase in swelling of the joint. It may be caused by preservatives in the medicine mix. The flare can develop within a few hours of the injection. It may last up to three days. This swelling will go away on its own. Applying ice to the area will help.
Sometimes, you may have a reaction to the local anesthetic used. Reaction can occur up to 30 minutes after the injection and may include:
  • Flushing (may include chills, shaking, and headache)
  • Hives
  • Chest or stomach pain
  • Nausea
Your doctor may limit the number of injections per year (eg, no more than four injections per year). Repeated use of injections may quicken normal age-related changes in the joint. This can cause problems with cartilage, ligaments, and tendons.
Talk to your doctor about these risks before the procedure.

What to Expect

Prior to Procedure

Before the procedure, your doctor will do a physical exam. Your doctor will also discuss risks associated with joint injections. Joint injections may not be a good choice if you:
  • Have had no relief from previous injections
  • Take blood-thinning drugs, such as warfarin (Coumadin), or anti-platelet drugs, such as clopidogrel (Plavix)
  • Have uncontrolled diabetes

Anesthesia

Your doctor may use a local anesthetic on your skin before giving the injection. This will make the area numb for a short time. Your doctor may also use a cold treatment to numb the skin.

Description of the Procedure

This procedure can usually be done in your doctor's office.
Your doctor will locate the site where the injection will be placed. The area may be marked with a pen or marker. The injection area will be wiped with an alcohol pad.
Your doctor may flex the joint being injected. The doctor will then inject the joint in the area where it is most swollen and tender. The needle will be inserted to the bone. It is then pulled back slightly before the injection is given.
The local anesthetic may provide immediate relief. It will also help your doctor confirm the diagnosis. The steroid may provide relief from pain, swelling, and inflammation for a longer period of time.

How Long Will It Take?

10-15 minutes

Will It Hurt?

You may have some pain when the injection is given. It is also possible that your symptoms may worsen for the first 24-48 hours after the injection. Talk to your doctor about steps to reduce pain.

Post-procedure Care

At the Care Center
Right after the procedure, the staff may:
  • Apply an adhesive bandage to the injection site.
  • Put your joint through range of motion.
  • Apply ice to the injection site for 15 minutes.
You will be able to leave after being monitored for 30 minutes.
At Home
When you return home, take these steps:
  • Follow your doctor’s instructions for caring for the injection site.
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
  • Avoid strenuous activity with the injected joint for several days.
  • Your doctor may recommend non-steroidal anti-inflammatory medicine (NSAID) for pain. You may need it during the first few days.
  • Your symptoms may get worse for 24-48 hours after the injection. You may also have a steroid flare. You can apply ice to the injected joint for 15 minutes at a time. Always wrap ice in a towel. Do not apply it directly to your skin.
  • Be sure to follow your doctor’s instructions.

Call Your Doctor

Call your doctor if you notice any signs of infection, such as:
  • Warmth or swelling at the injection site
  • Fever
  • Chills
If you have an emergency, call for medical help right away.

RESOURCES

American College of Rheumatology
http://www.rheumatology.org/
The Arthritis Foundation
http://www.arthritis.org/

CANADIAN RESOURCES

The Arthritis Society
http://www.arthritis.ca/
Public Health Agency of Canada
http://www.phac.gc.ca/

References

Beddoe AE, Schub T. Pain, chronic. CINAHL Nursing Guide. EBSCO Nursing Reference Center website. Available at: http://www.ebscohost.com/biomedical-libraries/the-cinahl-database. Updated January 20, 2012. Accessed May 28, 2012.
Cardone DA, Tallia AF. Diagnostic and therapeutic injection of the hip and knee. Am Fam Physician. 2003;67(10):2147-2152.
Cardone DA, Tallia AF. Joint and soft tissue injection. Am Fam Physician. 2002;66(2):283-289.
MacMahon PJ, Eustace SJ, Kavanagh EC. Injectable corticosteroid and local anesthetic preparations: a review for radiologists. Radiology. 2009;252:647-661.
Reilly DT. Ask the doctor: should I be worried about the side effects from cortisone shots? Harv Health Lett. 2012;37(6):8.

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