Joint injections are done for several reasons.
- It can help obtain a diagnosis by acquiring joint fluid for analysis when the source of the problem is unclear. For example, if a joint like the knee suddenly becomes swollen, obtaining fluid can help differentiate if it is due to an infection, gout, osteoarthritis or an inflammatory arthritis.
- It can help control pain and swelling in the joint by administering medications directly into the area. This helps particularly in people with an inflammatory arthritis like rheumatoid arthritis where joints can “flare-up”, even as they take their systemic therapy. It also helps with pain in those with the degenerative form of arthritis, otherwise called as osteoarthritis. It is important to remember that the effects of injections are usually temporary, and the underlying problem can recur if it is not addressed by other means. For the most part however, it can help to quickly, and significantly, relieve symptoms in that joint.
Your doctor can refer you for an injection at any point these indications are met, and we’d like to walk you through the process. No specific preparation is required prior to the procedure, and injections are performed at the bedside in clinic.
STEP 1: Assessment of the problem
When you are seen for an injection, an assessment of the problem area is done to ascertain that an injection is suitable for the location involved.
STEP 2: Examination of the joint
Part of determining whether an injection is needed for the problem, is an examination of the joint to try and determine the cause for the pain. In most cases, that may require an ultrasound examination prior to the injection.
STEP 3: Explanation of the procedure and signing of the informed consent
You will receive an explanation of the risks, benefits and alternatives to an injection, so you can decide if this is something you would like to pursue. If you agree to the procedure, then you will be asked to sign an Informed Consent.
STEP 4: Injection preparation
The doctor will prepare the medications required for the injection, which is usually a combination of a long-acting steroid preparation, mixed with an anesthetic/numbing agent. If you have had any allergic reactions in the past to such components, please inform your doctor.
STEP 5: Cleaning of the area and topical numbing
The area for the injection site is cleaned thoroughly with strong agents that kill bacteria on the skin, significantly decreasing the risk of contamination. When the area has been cleansed, a topical spray is administered that helps to numb the area in preparation for the injection. This spray has a cooling/freezing effect which helps to lessen pain.
STEP 6: Injection
The needle is then advanced into the area of interest. At times, because we would like to enter a very specific area inside the joint, ultrasound guidance is used.
STEP 7: Removal of fluid in certain cases
If there is significant fluid build-up, or an effusion within the joint, fluid is first aspirated. This helps to relieve pressure within the joint, but can also be sent for further testing if indicated.
STEP 8: Injection of medication
Once the needle is in the target location within the joint, the appropriate medications are then delivered into the area.
STEP 9 : Completion of procedure
Voila! The procedure is completed and the needle removed. A simple band-aid is applied and you are ready to go. You will be asked to avoid too much excessive activity using the injected joint for about 48 hours. Otherwise, some mild analgesics (NSAIDs, Tylenol) and ice for the area may be employed as needed. If any problems with increased pain, swelling, or bleeding happen following the injection, be sure to call your doctor about it. Thankfully, these are extremely rare and injections are well-tolerated and effective.