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Joint injections

Published by Bupa's health information team, July 2009.

This factsheet is for people who are having a joint injection, or who would like information about it.

Injections of steroid medication into joints are given to ease pain and reduce swelling, for example from injury or arthritis.

Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice.

About joint injections
What are the alternatives?
Preparing for your procedure
About the procedure
What to expect afterwards
Recovering from joint injections
What are the risks?
Questions and answers
Related topics
Further information
Sources

About joint injections

Steroid joint injections are given to help reduce pain and swelling, and to help you move the joint more easily. Many people have steroid injections into their shoulders, knees, elbows or hands, or joints that are affected by arthritis. Small amounts of steroids can also be injected into body tissue to treat conditions such as tennis elbow and carpal tunnel syndrome. This factsheet will focus on steroid injections into joints.

The steroids used for joint injections are similar to those produced naturally by the body. However, they aren't the same as the anabolic steroids used by body builders.

Your pain relief can last anything from one week to two months or longer, depending on the type of steroid you have injected. However, the injections shouldn't be repeated more than three times a year for each joint.

You can have joint injections in a hospital or at your doctor's surgery. This will depend on the joint that is being injected.

What are the alternatives?

The alternatives to joint injections will depend on what is causing your joint pain but alternative treatments could include painkillers and physiotherapy. Speak to your doctor about the options available to you.

Preparing for your procedure

Joint injections are usually performed as an out-patient or day-case procedure, sometimes with sedation. This will depend on which joint it is and how painful it is. Sedatives help you relax and you may also be given a local anaesthetic to numb the skin before the steroid is injected. You will be awake during the procedure.

If your injection is done in a hospital, your nurse may check your heart rate and blood pressure, and test your urine.

For certain joints your doctor may also use X-rays during the procedure. This helps him/her to direct the injection to the right spot.

Your doctor or another health professional will usually ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

About the procedure

Before your injection, your doctor will examine the joint. Your skin will be cleaned with a sterile wipe. Your doctor may also inject a local anaesthetic at the same time as the steroid. This local anaesthetic may provide immediate short-term pain relief. It will either be mixed with the steroid in the same syringe, or injected before the steroid.

You may have more than one injection depending on the joint that is swollen or causing pain.

If you have arthritis, you may have too much fluid in your joint making it feel tight and uncomfortable. If this is the case, your doctor may draw the fluid out with a syringe before injecting the joint. This is known as joint aspiration.

What to expect afterwards

If you have a local anaesthetic injected with the steroid, you may not have any pain for the first few hours. However, when the local anaesthetic wears off, your pain may be worse than before the injection. You will need to stay in the hospital for at least 30 minutes after the injection to make sure you don't have any immediate side-effects.

You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.

Before you go home, a physiotherapist may visit you. He or she will assess the movement you have in your joint and may give you some exercises to do at home.

Recovering from joint injections

You should rest the joint for 24 to 48 hours to allow the steroid to take effect. Try to completely rest the joint. If you aren't able to do this, keep movements to a minimum and don't do any strenuous activity. If you are having physiotherapy, your physiotherapist may encourage you to move the joint while it isn't painful.

Your doctor may encourage you to continue to use ice to reduce any pain or swelling in the joint. You shouldn't apply ice directly to your skin as it can damage your skin.

Follow your doctor's advice on returning to work and normal activity.

It is possible that you might have a reaction after having your joints injected and you may have an increase in your pain, which may go on for up to two weeks. If you develop any of the following symptoms soon after your joint injection, contact the hospital immediately.

A high temperature.
Increased redness or swelling around the joint.
Wheezing or a tight chest.
An increase in the amount of pain you have in the joint.

Sedation temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your doctor's advice.

What are the risks?

Joint injections are commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

These are the unwanted but mostly temporary effects of a successful joint injection.

You may feel more pain and tenderness than usual in the injected area for a day or two. You can use ice to treat this, although you shouldn't apply ice directly to your skin as it can damage your skin.

Complications

This is when problems occur during or after the procedure. Most people are not affected.

It's possible to have an unexpected reaction to the anaesthetic or excessive bleeding during or very soon after a joint injection. Specific complications are rare but there is a small risk that injecting a joint can cause an infection. The risk of infection may increase depending on your general health. If an infection occurs it may need treatment with antibiotics. Other rare complications include damage to nerves, tendons or other structures near the joint that has been injected. Your doctor will explain what the risks are depending on the joint that is going to be injected and the approach he/she will take.

Injecting steroids into the joint rather than taking them orally or injecting them into the bloodstream will reduce any side-effects you may have. Rare side-effects from repeated steroid injections include:

weakening of the bones, which can lead to osteoporosis
weakening of the muscles and ligaments around the injected joint
a flushed or red face
changes to the menstrual cycle in women
weight gain or an increase in your appetite
bruising easily
indigestion and stomach pains
cataracts
changes in your mood, for example feeling more depressed
thinning of the skin around the injection site

The side-effects from steroids will depend on the dose and type of steroid your doctor uses, and how many times you have repeat injections. The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your doctor to explain how these risks apply to you. If you're not having repeat injections, then the risk of side-effects from the steroids will be minimal.