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Joint injections

Joint injections

Corticosteroid or hyaluronic acid joint injections for knee, shoulder and other joint pain when the usual approach isn't enough.

What a joint injection is

It consists of administering a medication directly into the joint or next to the painful tendon, rather than systemically. The benefit for the patient is twofold: it reaches the required area in a concentrated manner and reduces the exposure of the rest of the body to the medication.

  • Corticosteroid: a powerful anti-inflammatory. It provides rapid relief in severely inflamed conditions; it is not repeated indefinitely because excessive use can damage the tissue, and nowadays every effort is made to avoid it where possible.
  • Hyaluronic acid: improves joint lubrication. Highly indicated in moderate osteoarthritis and degenerative meniscal tears. It works more slowly and its effect is measured in months.

Common indications

  • Knee or hip osteoarthritis with pain that limits daily life.
  • Painful shoulder, bursitis and rotator cuff tendinopathies.
  • Epicondylitis, fasciitis and other selected enthesopathies.
  • Carpal tunnel syndrome and trigger finger.

How it is performed

It is performed in the clinic using a sterile technique and, when required by the joint, under ultrasound guidance to ensure the medication reaches the exact location. It takes just a few minutes. It is common to feel some discomfort during the injection and, with corticosteroids, a temporary flare-up in pain during the first 24 to 48 hours before improvement occurs. Relative rest, applying ice locally, and avoiding straining the joint are recommended during those days.

What to expect, honestly

The injection does not cure osteoarthritis, nor does it replace fundamental treatment: it provides relief and opens a window of opportunity to engage in what truly alters the prognosis, which is physiotherapy and strength training. This is why it is prescribed as part of a comprehensive plan and not as an isolated solution. Joint infection is a contraindication for corticosteroid injections (triamcinolone). In patients with diabetes or those on oral anticoagulant therapy, the injection is evaluated with caution, at the discretion of the orthopaedic specialist.

Frequently asked questions

Is it true that injections wear out the joint?

Corticosteroids repeated to excess can damage the tissue, which is why they are not repeated indefinitely nor used as a stand-alone measure. Properly indicated and adequately spaced, they relieve pain and open a window to do what really changes the outlook: physiotherapy and strength exercise.

Does it hurt more after the injection?

With corticosteroid it is common for pain to increase in the first 24 or 48 hours before the improvement. Relative rest during those days is recommended, along with local ice and not straining the joint. If the pain is severe and increasing, or a fever appears, you should seek advice.

Are they done under ultrasound guidance?

When the joint or the tendon calls for it, yes: ultrasound guidance ensures the drug reaches the exact spot, and in some locations it makes the difference between it working or not. It is approached with caution in decompensated diabetes, anticoagulation and infection.

What should you avoid doing after a knee injection?

Avoid intense exercise, impact and heavy loads for 48 hours, and do not push the joint even if the pain has gone: that feeling of improvement can lead you to overload it. You can walk normally. Get in touch if you develop a fever or the pain increases instead of easing.

How long does the effect of a knee injection last?

With corticosteroid, relief usually lasts weeks or a few months; with hyaluronic acid, the effect comes on more slowly and can last several months. Neither cures osteoarthritis: they open a pain-free window in which to do the strength work that does change the course of it.

Content reviewed by Dr Agustín Fernández Palomero

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