Joint Injections For Pain

About Joint Injections

Joint injections, a Premier Diagnostic Imaging service, provide relief from pain in joints. The medication can be injected into any joint, and is most often injected in the hip, shoulder or knee. 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, stiffness, and other symptoms caused by inflammation or irritation of the joint and surrounding structures. The pain relief can last from several days to several months. Patients who have recent onset of pain or milder pain may respond better than those with a longstanding pain or severe pain.

What to Expect

The injection typically consists of a local anesthetic and a corticosteroid medication (such as methylprednisolone and triamcinolone, formulated to stay primarily in the joint). The steroids are anti-inflammatory agents that slow down the accumulation of cells responsible for producing inflammation and pain within the joint space. The actual injection takes only a few minutes.

The procedure involves inserting a needle through the skin and deeper tissues, which involves some pain. However, your skin and deeper tissues will be numbed with a local anesthetic using a very thin needle before the joint injection is made. The local anesthetic wears off after a few hours.

Immediately after the injection, you may feel that your pain is gone or is 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 3-5 days after the procedure.

If the first injection does not relieve your symptoms in 2-3 weeks, your doctor may recommend one more injection. If you respond to the injections and still have residual pain, you may be recommended for further injections depending on the underlying condition of the joint.

In a 6-12 month period, we generally prefer not to perform more than three injections. If three injections have not helped you much, it is very unlikely that you will get any further benefit from more injections. Also, giving more injections will increase the likelihood of steroid side effects. If the injections are not working, stronger consideration may need to be given to orthopedic surgery.

How to Prepare

Plan to take it easy for a day or so after the procedure, as your joint may be sore. You may want to apply ice to the affected area. Perform activities as tolerated by you. Unless there are complications, you should be able to return to work the next day. If you are allergic to any of the medications involved in the injection, if you have an active infection, or if you have poorly controlled diabetes or heart disease, you should not have a joint injection or at least consider postponing it.

You must have a driver the day of your procedure, as you will not be allowed to drive home afterward. We recommend that someone stay with you for 12 hours following the injection. Drink plenty of clear fluid up to one hour prior to your procedure to stay hydrated. Caffeinated beverages (colas, teas, coffee, etc.) are recommended to help prevent post-procedure headaches. You should not eat any solid food for four hours prior to the exam. If you are on antiplatelet or blood thinning medications, stop medications for the recommended periods below:

• Warfarin (Coumadin) – Stop 5 days prior to procedure
• LMWH – Stop 24 hours prior to procedure
• Antiplatelet medications:
  • Aspirin, NSAIDS, and Persatine, etc. – Stop 48 hours prior to procedure
  • Apixaban (Eliquis) – Stop 3 days prior to procedure
  • Pradaxa (Dabigatran) – Stop 5 days prior to procedure
  • Plavix (Clopidogrel), Effient (Prasugrell) – Stop 7 days prior to procedure
  • Ticlopidine – Stop 14 days prior to procedure