Joint pain treatment (joint injections)

Joint injections are a quick procedure to inject hydrocortisone (a type of steroid) directly into an inflamed, swollen joint. Damage or injury to a joint can cause chronic joint pain and make it harder to enjoy everyday activities such as:

• Driving
• Playing sport
• Walking around easily

Conditions that may cause joint pain include:

• Arthritis
• Bursitis (housemaid’s knee)
• Osteoarthritis
• Tendonitis (tennis elbow)

A joint injection could benefit you by reducing inflammation and swelling in the affected joint, especially if you're experiencing:

• Elbow pain
• Hip pain
• Knee pain
• Shoulder pain
• Wrist pain

After a joint injection, your pain should improve and you can move your joint more easily, allowing you to get back to your usual routine. If you don’t think injections are for you, hydrocortisone can also be received in the form of skin creams, foam and tablets.

These steroids are only available with a prescription. Before recommending joint injections, your GP will ask about your general health and may check your blood pressure and blood sugar, as hydrocortisone can raise these.

You’ll also need to let your GP know if you have diabetes, glaucoma or osteoporosis, as hydrocortisone can worsen these conditions. Hydrocortisone isn't suitable for everyone, so you should tell your GP if you:

• Are allergic to hydrocortisone or other medicines
• Have depression or bipolar disorder, or if any members of your family have these illnesses
• Have an infection, or have recently come in close contact with somebody with chickenpox, measles or shingles
• Are trying to conceive, currently pregnant or you’re breastfeeding
• Have recently had or will soon have any vaccinations

You won’t have to wait long to find out if joint injections are right for you, and if you have more than one painful joint you can discuss whether to have them treated at the same time. Don’t worry if this procedure isn’t for you as there are plenty of alternative treatments available instead of joint pain injections, such as anti-inflammatory tablets and physiotherapy.

Joint injections contain hydrocortisone, a type of steroid called a corticosteroid, which slowly suppresses the chemicals that cause inflammation. This is different from an anabolic steroid, which is the type that helps increase your muscle mass.

A consultant carries out an intra-articular injection where the hydrocortisone is injected directly into your joint. This helps the treatment work faster and reduces the risk of any side effects.

The dose of hydrocortisone you’ll receive depends on the size of your joint, you can expect it to be anywhere between 5mg and 50mg.

Your doctor may use a local anaesthetic to numb the injection site so you don’t feel any pain from the injection itself. Your doctor may also perform an aspiration and remove synovial fluid from your joint before your hydrocortisone injection.

Some people find their joint pain improves hours after their injection, but it can take a few days. You can expect the effects to last for a few weeks or up to a year, depending on the type of injection you have. If needed, you can receive hydrocortisone injections in the same joint for up to four times in the year, but any more than this could cause irreversible joint damage. Your doctor will discuss how much hydrocortisone you need, depending on how severe your chronic pain is and your general health.

Who will be involved?

An orthopaedic surgeon or consultant radiologist can inject the hydrocortisone into your joint. There may also be a nurse or assistant at your appointment.

How to prepare for a joint injection

If you take blood-thinning medication, you may need to stop taking these in the days building up to your joint injection as they can increase your risk of bleeding and bruising. You should also tell your doctor if you have any conditions that affect how well your blood clots. You may need to stop taking other medications and supplements too, but your consultant should’ve discussed this with you.

You can eat and drink as normal before your treatment, but you must tell us if you have diabetes as the injections could increase your blood sugar levels. You can wash before your treatment but must not apply any cosmetic products, including any prescribed creams or rubs for your joint pain.

It’s a good idea to wear loose and comfortable clothing with easy access to the joint being injected. You may also be asked to sign a consent form.

How long do joint injections take?

Joint injections usually take around 20 minutes. They may take longer if your doctor decides to perform an ultrasound scan to help target the inflammation precisely.

Anaesthetics

Before the procedure you may be given a sedative, so you feel very calm. Your doctor may numb the area by injecting some local anaesthetic into your joint. Sometimes they may combine the anaesthetic and hydrocortisone in the same syringe, so you only need one injection.

Pain after joint injections

You’re likely to feel some pain afterwards from the injection itself. If you had a local anaesthetic during the treatment, this will help with the pain but will wear off after a couple of hours. You can apply an ice pack around your joint to relieve pain but you should avoid heating pads. You can also take over-the-counter painkillers for pain management, such as:

• Ibuprofen
• Paracetamol

It's a good idea to arrange to have a lift home because the numbness from the local anaesthetic and discomfort from the injection can make it difficult to drive.

Any discomfort or bruising you feel around your joint afterwards should go after a few days, and you should be free of the chronic pain caused by your inflamed joint.

You’ll be able to go home a couple of hours after your injection. It’s best to avoid any heavy exercise and rest your joint for a couple of days until any pain from the injection has gone. After this, you can begin to move and exercise your joint as the hydrocortisone should have taken effect and the pain and stiffness in your joint should have improved. Your doctor will advise on when to return to work if you have a strenuous job.

You could benefit from physiotherapy once you’re pain-free and can exercise your injected joint more easily. Your physiotherapist can show you exercises that will help to strengthen your joint.

Most people have no complications from their joint injection, but as with most medical procedures, they are possible. Common short-term side effects of your injections include:

• Intense pain and swelling – though this should go away after a couple of days
• Bruising around the joint
• Facial flushing

In rare cases, hydrocortisone from your injected joint can reach the bloodstream. This is more likely if you have repeated injections. If this happens, there’s a very small risk of developing more serious complications. If you believe you have any of these side effects, call your doctor right away:

• Depression – including suicidal thoughts, mood swings, anxiety, or strange and frightening thoughts
• High blood pressure
• High blood sugar – you may feel sleepy, confused, hungry or thirsty, as well as experiencing changes in your urination frequency, breathing and breath
• Infection – you may have a fever (temperature over 38°C), chills, or pains around your throat, ear, and sinuses
• Osteoporosis – weakened and fragile bones
• Thinning skin
• Signs of Cushing’s syndrome – weight gain in the upper back, belly or face, headaches and slow wound healing

Your doctor will talk these through with you so you can make an informed choice about the benefits and any risks of your course of treatment and will monitor you throughout. You should also call your doctor if you feel breathless, have swollen arms or legs, or experience changes in your eyesight following your injections.

In some cases, steroid injections can increase your blood sugar levels for up to a week after the procedure. If you have diabetes, you should carefully monitor your blood glucose levels during this time and call your doctor if you have any concerns.

Hydrocortisone can cause problems in the first trimester (12 weeks) of pregnancy and you should talk to your doctor if you’re trying to conceive or if you’re already pregnant before having an injection. It may also interfere with your menstrual cycle. Otherwise, it’s safe to have joint injections while breastfeeding.

Some medicines can interfere with the way that hydrocortisone works, so it’s important to speak to your doctor or pharmacist before starting or stopping any medicines, herbal remedies, vitamins or supplements.

At Spire hospitals, your safety is our top priority. We have high standards of quality control, equipment and cleanliness and a rigorous system of review and training for our medical teams.