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Generally the patient will require at least a plain X-ray of the joint and often an ultrasound, CT scan, or MRI. These imaging studies should be brought to the appointment.
Reasonable suspicion of synovitis as cause for the patient’s symptoms, and a failure to respond to a trial of NSAIDs and physical therapy, is the commonest reason to refer a patient for joint injection.
Infection in or overlying the joint
This is a very safe procedure with few risks.
There is a risk of infection, which is very small and probably lies between 1 in 20,000 and 1 in 75,000 injections performed. The procedure should not be performed if there is broken skin or infection overlying the joint or if the joint may already be infected.
There are possible complications of the steroid injection, which include aggravation of the pain due to irritation of the joint lining by crystals in the steroid solution.
If the steroid is not injected solely into the joint there is a risk of damage to the soft tissues at the injection site including atrophy of the skin or subcutaneous fat and rupture of the tendons around the joint.
Although the exact risk is not known, most doctors would advise against injection more than 3-4 times a year to avoid damage to the joint.
Occasionally, people are allergic to the injected medication (as with any drug). The exact risk of this is not known but it seems to be very uncommon. The radiologist should be advised on the referral if there is known iodine allergy and/or a prior contrast reaction. An ultrasound guided injection does not use X-ray contrast (ICM) but this may be used if the injection is done using fluoroscopy or CT.
Last saved on 13 October 2016.
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RANZCR® intends by this statement to exclude liability for any such opinions, advices or information. The content of this publication is not intended as a substitute for medical advice. It is designed to support, not replace, the relationship that exists between a patient and his/her doctor. Some of the tests and procedures included in this publication may not be available at all radiology providers.
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