Joint Injections
Joint injections—also known as an intra-articular injection—use a local anesthetic and a medication injected directly into the joint to relieve pain and inflammation. There are three common types of joint injection:
- Corticosteroid injections
- Hyaluronic injections
- Nerve blocks
The one that works best for you depends on your condition and which is more closely matched to your therapeutic goals.
A single joint injection has the potential following benefits:
- Reduced inflammation: A 2019 review of studies found that joint injections of hyaluronic acid increased joint lubrication and reduced inflammation
- Pain relief: In one study of SI joint injections, nearly 67% of patients had a significant reduction in pain for at least six weeks
- Increased mobility: For frozen shoulder, a joint injection eased pain and increased shoulder mobility in participants for three to six months
The overall benefit of a joint injection will depend on the condition being treated, other concurrent treatments, and a patient’s overall health.
There several different types of joint injections that are paired with the painful joint being treated. Let’s look at each of these in more detail.
Facet Joint Injections - Your facet joints connect and stabilize each individual spinal vertebra in relation to the one above and below it. These connections are strong but surrounded by sensitive nerves. Whenever injury or deterioration causes inflammation, pain can result.
Facet joint injections are a good option to treat pain that occurs in the back and neck. Common conditions that cause this type of pain include: spinal stenosis, herniated disc, sciatic, and/or spondylolysis.
Research has shown that facet joint injections offer a significant decrease in pain and also work as a reliable diagnostic tool to determine if you are a candidate for radiofrequency ablation (RFA), another treatment. Further, patients who undergo facet joint injections are generally better able participate in rehabilitative therapies that compound their pain-relieving effects.
SI Joint Injections - Your sacroiliac joint connects the legs to the pelvis and is the center of some of the most difficult pain to treat. When injury to this joint occurs, pain can cross the lower back and shoot down the legs. Trauma to the SI joint from injury, pregnancy and childbirth, or hip or spine surgery can cause painfully tight ligaments in this joint. Degenerative sacroiliitis can occur with autoimmune conditions, and pain may also be present with an uneven gait. SI joint injections relieve pain in the majority of patients and are also used as a diagnostic tool.
Hip Joint Injections - Our hips are the largest weight-bearing joint in our bodies. As such, they are subject to a tremendous amount of stress with literally every step we take. Hip joint injections are used to help restore pain-free mobility.
Osteoarthritis is the most common cause of hip pain, but other hip pain causes include: bursitis, rheumatoid arthritis and/or injury and prior trauma. When performed to excess, this type of injection may increase the rate of progression of osteoarthritis in a small minority - about 8% of patients. In the same study, however, researchers also found that many patients can benefit from exploring this treatment (and its risks) before trying more invasive and riskier procedures (e.g., surgery).
Knee Joint Injections - The knee is made up of a variety of bones, muscles, tendons, and ligaments. These intertwine and wrap around the knee to help provide stable, balanced movement in the lower body. But this structure is remarkably vulnerable to injury, and pain in the knee makes simple daily tasks excruciating. Knee joint injections work to ease pain and decrease inflammation most commonly caused by injury and various forms of arthritis.
Knee joint injections are most successful when their placement is accurate. Fluoroscopically-guided injections are the best choice for this type of joint injection. Like other injections, they can also help you undergo rehabilitative therapies to correct an underlying issue.
Shoulder Joint Injections - Shoulder joint injections can address common causes of shoulder pain, including: frozen shoulder, dislocation, bursitis, arthritis and/or injury.
Ankle Joint Injections - Ankle joint injections can help relieve pain when over-the-counter medications have not been effective. They are also a great option to try before more interventional pain treatments and when the ankle injury is causing significant pain, swelling, or deformity.
Conditions that might cause ankle pain include: injury, rheumatoid arthritis, osteoarthritis, tarsal tunnel syndrome, bursitis, tendonitis, gout and/or synovitis. This type of injection for joint pain is also a great way to stabilize the joint so that physical therapy and other complementary treatments can begin. Ankle joint injections are a minimally-invasive treatment option that improve quality of life and reduces pain.
Elbow Joint Injections - Elbow joint injections are frequently recommended when rest and other comfort measures do not provide healing for elbow pain.
The most common causes of elbow pain are tennis and golf elbow. Both of these conditions place excessive strain on the tendons on either the outside or inside of the elbow. This strain can cause swelling and inflammation, which can lead to permanent damage if not treated.
Overview
Before recommending a joint injection procedure, you and your doctor will discuss the potential side effects, risks, and indications for success. An educated patient is better able to make good decisions about their treatment. As noted below, there are a variety of complimentary treatments for joint pain, and it’s important to discuss all of your options first.
The joint injection procedure itself is an outpatient procedure that is generally the same regardless of the joint being treated. You can see an overview in the following knee joint video, or keep reading.
Step 1: Prepare the area around the affected joint
You will be positioned on the examination table to expose the affected joint. For many injections, it is not necessary to change out of your regular clothes. Wear loose, comfortable clothes to allow easy access to the joint.
Once you are settled on the table, your doctor will clean and sterilize the skin around the joint to minimize the potential for infection.
Step 2: Administer local anesthetic
A local anesthetic makes your joint injection more comfortable. This anesthetic is injected into the skin. You may first receive a topical anesthetic to make the local anesthetic injection less painful, as well.
Step 3: Use fluoroscopic (X-ray) guidance to guide the injection
Another way to minimize the chance of side effects (and to maximize pain and inflammation relief) is by using fluoroscopic guidance. This helps your doctor precisely administer the medications exactly where they are needed.
Fluoroscopy is not necessary for every injection, but in areas where the injection site is more precise (e.g., shoulders, hips, and the jaw) it is helpful for best results. The entire procedure usually takes between five and ten minutes.
In addition to reducing pain and inflammation, the goal is for this procedure to be safe and comfortable. Many patients avoid getting a joint injection because they are worried that it might be painful. Know that your doctor is committed to your comfort at every step of your joint injection.
To that end, a topical anesthetic and a local anesthetic will go a long way to minimize discomfort. You may feel a pinch when the topical anesthetic is injected, but in general, most patients report only mild discomfort.
If you are concerned about pain, or you feel nervous about needles in general, talk to your doctor. They may prescribe a mild sedative for you before the procedure to ease your worry and ensure your comfort.
Risks
Joint injections as a whole are generally recognized as safe, but as with any interventional procedure, there are potential side effects and risks to be aware of.
Potential side effects include:
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Allergic reaction to injected medication
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Allergic reaction to skin disinfectant or bandage tape adhesive
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Temporary increase in pain
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Bruising at the injection site
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Mild swelling at the injection site
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Thinning bone at the injection site
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Nerve damage
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Damage to or death of nearby tissue
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Corticosteroid side effects, such as headaches, facial flushing, hot flashes, anxiety, and insomnia
Very rare but potentially serious risks include infection in the injected joint and post-injection flare. Thinning and whitening of the skin around the injected joint is another potential risk, as is rupture of the tendon.
Avoid serious side effects and complications by limiting the number and frequency of injections in a joint, in consultation with your doctor. Joint injections should not be performed in a joint with active infections or if you have a known allergy to the medication being injected.
Frequency
A joint injection has great potential for pain relief and increased mobility, but as noted above, they do come with some risks. To avoid these risks, your doctor will limit the number of injections you receive in a year, carefully monitoring the joint (and the rest of your health) for potential side effects.
Generally, you should limit joint injections to no more than three or four in a year. Many people find that the first couple of joint injections, spaced at least six weeks apart, offer them enough pain relief and mobility to begin complementary therapies, like chiropractic care or physical therapy.
Joint pain conditions are also best treated with a comprehensive approach that includes proper sleep, diet, and lifestyle changes. In some cases, joint injections allow you to incorporate these other therapies into your treatment plan for the best chance of successful healing.
Recovery
Joint injection recovery is generally quick, but there are a few things to keep in mind on the days that follow your joint injection. Talk to your doctor for a specific list of joint injection recovery instructions, but here are a few general guidelines.
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Have a friend or family member drive you home after your joint injection
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Resume all regular activity the day after your joint injection, but take it easy on the procedure day itself
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Apply ice to reduce pain and swelling at the injection site as needed, 20 minutes on and 20 minutes off
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Avoid saunas or other heat to the injection site for three days (regular hot showers are fine, but no baths until your doctor says it is okay)
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Consult with your doctor about your current medications and if you should take them before or after the procedure
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Remove the bandages if they get wet from bathing
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Corticosteroid side effects as noted above are common, so take comfort measures as needed (e.g., over-the-counter headache relief, cool washcloths for hot flashes, and herbal teas for sleep and calming anxiety)
It is also common to feel a slight increase in pain after your joint injection. This is nothing to be alarmed about and is entirely normal. If pain increases substantially, or you have signs of infection at the injection site (fever, redness, swelling, or discharge), contact your doctor.
Relief
Many patients expect instant pain relief and restored mobility from their joint injections. For some lucky patients, this does actually occur. They hop off the examination table and feel great.
More commonly, your joint injection may take up to ten days to take full effect. It may even feel discouraging when pain worsens slightly in the days following the injection. The local anesthetic numbs the painful area, and as that wears off, the pain returns.
Take heart: this is common and temporary. Expect to begin to feel gradually less pain and increased range of motion over a ten-day period. If you receive multiple joint injections (i.e., one on either side of your knee) you may feel relief on one side and pain on the other. Of course, if you do not feel relief after ten days, it’s best to schedule a follow-up with your doctor to learn more.
