Joint Injection

A joint injection is a way of putting an anti-inflammatory medicine directly (with a needle) into an inflamed joint. The medicine is an anti-inflammatory steroid similar to cortisone.

The medicine usually causes a rapid decrease in the inflammation, making the joint less painful and less swollen. We expect the injection to control the inflammation for six to 12 months. Sometimes it works for a longer period of time, and sometimes for a shorter period of time. In people who have a poor or incomplete response to the first injection, a second injection may be recommended and often works much better. A good response to an injection may permit us to eventually decrease the other medicine(s) you are taking.

Whenever possible, we apply a numbing cream (EMLA) to the skin about one hour before the injection. The skin over the joint is cleaned carefully with betadine and alcohol. A cold spray called ethyl chloride is sprayed on the skin to numb it and then a very small needle is used to inject numbing medicine under the skin. This numbing medicine is called lidocaine and is similar to that used by dentists. We do not numb finger or toe joints since we use the same size needle to inject the cortisone as we do to inject the numbing medicine.

If you are anxious about the injection, we can give you a sedative (Versed). The medicine will not cause you to fall asleep, but it may make you more relaxed or a little giddy. After the injection, you may be a little sleepier for the rest of the day, be unsteady on your feet and need help getting to the car. 

You also may be more clumsy and require supervision by a companion for the rest of the day. It is OK for you to eat and drink, or nap.

Side effects are uncommon, but you need to know that:

• The joint might become infected in the first two days after the injection. If that happens, your joint will be very painful, red, quite warm and you may have a fever. Infection is very rare. It happens in about one out of 50,000 injections.
• The skin near the injection site might become thin (atrophic) or turn white. This may slowly return to normal over a few years or it may be permanent.
• Initially, the medicine may irritate the joint and it might hurt for several hours before it starts to feel better.

For the first 24 hours after the injection, avoid soaking the joint: no swimming, hot tubs or baths (showers are OK). It is OK to do normal activities, but avoid vigorous things like running, biking, football, etc. The nurse will call a few days after the injection to see how things are going. You should call sooner if the joint
appears red, feels warm or becomes more painful.

Contact Telehealth Nursing at 651-229-3890 if any of the following conditions are present: 

• Fever over 101.5° degrees
• Throat irritation 
• Severe pain