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Joint injection

If you are considering having a joint injection or have a procedure planned, it is important to know all you can about it. This includes:
 
  • why you need this procedure
  • what it will be like
  • how it will affect you
  • what risks are involved
  • any alternatives.
 
The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your treatment choices with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.
 

What is the problem?

You have a painful condition affecting one or more of your joints. This may be because of an injury, general wear and tear, or an inflammatory illness. Rheumatoid arthritis is an example of an inflammatory illness, where the joints may be injected as a treatment for pain.
 

What is a joint injection?

Joint injections are used to treat a number of different painful conditions. As the name suggests the injections are given into a particular joint. The needle is inserted through the skin and underlying tissues, and then into the capsule, which is the outer covering of the joint.
 
Local anaesthetic and anti-inflammatory steroid drugs can be injected into the joint. By doing this, painful conditions affecting one or more joints can be treated. Inflammation and pain in the joint can be reduced.
Joint injection
If used, only a small amount of steroid is needed. It will not cause any of the side effects sometimes associated with taking steroid tablets. They are not the same kind of steroids that athletes may take.
 

What is a joint?

A joint is where the ends of two or more bones come together. Joints allow movement from side-to-side, up and down and also rotation. To stop bones rubbing against each other and to make the movement smooth, there is a special lining covering the ends of the bone, called cartilage. This is a hard, smooth and slippery surface that allows easy movement without much friction. In the lining of the joints there is also a soft membrane called the synovium. Synovium keeps the joint in good order and well lubricated. Again, this keeps movement smooth and free.
Joint injection 2

What has gone wrong?

Joints can become painful through injury or by simple wear and tear. Sometimes the smooth cartilage may be worn away. Then bone rubs against bone when the joint is moved. In addition, the synovium can become inflamed and cause pain. This is more common with an inflammatory illness.
Joint injection 3

The aims

The aim of the procedure is to reduce inflammation and pain in the joint. It is hoped that this will give long lasting relief from your pain. 
 

The benefits

Your pain should be reduced and you should be able to move around more easily. It will be easier to perform your daily activities and the number of painkilling tablets that you need to take will be reduced. If successful, this treatment may delay the need for surgery on a painful joint.
 

Are there any alternatives?

By the time that you consider a joint injection, you should have already tried other more simple treatments. These include rest, painkilling and anti-inflammatory tablets, and physiotherapy with exercise.
 
You may also have tried a transcutaneous electrical nerve stimulation (TENS) machine for your pain. This works by sending soothing pulses across the surface of the skin and along the nerve fibres. The pulses prevent pain signals from reaching the brain. They also stimulate your body to produce higher levels of its own natural painkillers, called endorphins.
 

What if you do nothing?

If you do nothing there are several things that may happen:
 
  • With time and rest the pain in the joint may settle on its own
  • The pain and difficulty in moving may remain the same
  • The pain may increase
 

Who should have it done?

The following patients should have the procedure done:
 
  • Patients with joint pain that has not responded to earlier treatments such as rest, tablet medicines or physiotherapy
 
Who should not have it done?
Each patient has the final decision on whether to proceed or not. If you are unhappy about the procedure for any reason you should not continue.
 
There are specific medical situations when a joint injection should not be done and they are as follows:
 
  • When a patient is on medication that prevents blood from clotting, such as warfarin. This would lead to more bleeding than normal. It may be possible to stop the medication a few days before the procedure. This will need to be discussed with your doctor
  • When a patient is suffering from an illness that prevents blood from clotting, such as haemophilia. This would also lead to more bleeding than normal
  • When there is infection of the skin over the site where the needle needs to be put in. This could cause infection in the deeper tissues.
 
Author: Dr Sean White FRCA. Consultant in pain and anaesthesia
© Dumas Ltd 2006
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