Author: A/Prof Howard Galloway*

What are the prerequisites for having a joint injection done?

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.

What are the absolute contraindications for a joint injection?

Infection in or overlying the joint

What are the relative contraindications for a joint injection?

  • Reflex sympathetic dystrophy:
    Any procedure or minor injury may reactivate or aggravate the symptoms. The Reflex Sympathetic Dystrophy Syndrome Association guideline recommends the avoidance of all types of even minor procedures on the affected limb.
  • Avascular necrosis of bones adjacent to the affected joint:
    Anecdotal reports suggest that intraarticular injection aggravates the pain of avascular necrosis.
  • Anticoagulation:
    There is no evidence to suggest that injection is contraindicated for patients on anticoagulation within the normal therapeutic range.
  • Failure to respond to previous injection.

What are the adverse effects of a joint injection?

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.

Are there alternative imaging tests, interventions or surgical procedures to a joint injection?

  • Conservative management with NSAIDs and physical therapy.
  • In some cases surgical washout and debridement may be considered.
*The author has no conflict of interest with this topic.

Page last modified on 26/7/2017.

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