After being monitored for a short time, you can usually leave the office or suite. Someone must drive you home. Patients typically resume full activity the next day. Soreness around the injection site may be relieved by using ice and taking a mild analgesic Tylenol. You may want to record your levels of pain during the next couple of weeks in a diary. You may notice a slight increase in pain as the numbing medicine wears off and before the corticosteroid starts to take effect.
If the joint that was treated is the source of pain, you may notice pain relief starting two to seven days after the injection. Pain may be relieved for several days to several months, allowing you to participate in physical therapy. If injections were helpful and you experience a later recurrence of pain, the procedure can be repeated. With few risks, steroid joint injections are considered an appropriate nonsurgical treatment for some patients. The potential risks associated with inserting the needle include bleeding, infection, allergic reaction, headache, and nerve damage rare.
Corticosteroid side effects may cause temporary weight gain, water retention, flushing hot flashes , mood swings or insomnia, and elevated blood sugar levels in diabetics. These effects usually disappear within days. Patients who are being treated for chronic conditions e. Links SpineUniverse. Regulates salt and water balance and has an anti-inflammatory effect. We comply with the HONcode standard for trustworthy health information.
This information is not intended to replace the medical advice of your health care provider. Patients who come to Mayfield with neck and back problems are given a rapid review of their medical condition within a few days, not weeks. It's a treatment process called Priority Consult.
Nearly 80 percent of our spine patients are able to recover with nonsurgical treatment. They offer physical therapy, exercise, medication, massage, trigger point injections, and various other spinal injections epidural steroid, facet, sacroiliac. We also perform these services at most outpatient centers in the Greater Cincinnati area. To make an appointment call Make an Appointment. Many Mayfield spine patients have the option of same-day, outpatient spine procedures at our spine surgery center.
Marc Orlando describes step-by-step what to expect during a facet joint injection for arthritic back pain. Steroid injection for joint pain Overview A steroid injection is a minimally invasive procedure that can temporarily relieve pain caused by an inflamed joint. What is a steroid joint injection? Injections can be made in the following areas: facet joints of the spine sacroiliac joint and coccyx hip joint shoulder, elbow, and hand knee, ankle and foot Who is a candidate?
Who performs the procedure? What happens before treatment? What happens during treatment? Step 1: prepare the patient The patient lies on an x-ray table. Mayfield services Patients who come to Mayfield with neck and back problems are given a rapid review of their medical condition within a few days, not weeks. Finally, avoid injecting several large joints simultaneously because of the increased risk of hypothalamic-pituitary-adrenal suppression and other adverse effects.
Dosing is site dependent. As a rule, larger joints require more corticosteroid. Table 3 lists general corticosteroid dosing guidelines. Before injection of a joint or soft tissue, a small quantity of 1 percent lidocaine or 0. For the actual joint or soft tissue injection, most physicians mix an anesthetic with the corticosteroid preparation. This provides temporary analgesia, confirms the delivery of medication to the appropriate target, and dilutes the crystalline suspension so that it is better diffused within the injected region.
Manufacturers advise against mixing corticosteroid preparations with lidocaine because of the risk of clumping and precipitation of steroid crystals. However, the authors have never experienced this as a major problem. For most injections, 1 percent lidocaine or 0. The dose of anesthetic varies from 0. On rare occasions, patients exhibit signs of anesthetic toxicity, including flushing, hives, chest or abdominal discomfort, and nausea.
It can take as long as 20 to 30 minutes following the injection for these symptoms to present. For this reason, and to monitor for allergic reactions, patients should be observed in the office for at least 30 minutes following the injection. A number of potential complications can arise from use of joint and soft tissue procedures.
Joint injections should always be performed using sterile procedure to prevent iatrogenic septic arthritis. Local reactions at the injection site may include swelling, tenderness, and warmth, all of which may develop a few hours after injection and can last up to two days. A postinjection steroid flare, thought to be a crystal-induced synovitis caused by preservatives in the injectable suspension, may occur within the first 24 to 36 hours after injection.
Soft tissue fat atrophy and local depigmentation are possible with any steroid injection into soft tissue, particularly at superficial sites e. Periarticular calcifications are described in the literature, but they are rare. Tendon rupture can be avoided by not injecting directly into the tendon itself.
Systemic effects are possible especially after triamcinolone acetonide [Aristocort] injection or injection into a vein or artery , and patients should always be acutely monitored for reactions. Alterations in taste have been reported for one to two days after steroid injection. Hyperglycemia is possible in patients who have diabetes.
To avoid direct needle injury to articular cartilage or local nerves, attention should be paid to anatomic landmarks and depth of injection. Other rare, but possible, complications include pneumothorax when injecting thoracic trigger points , perilymphatic depigmentation, steroid arthropathy, adrenal suppression, and abnormal uterine bleeding. Informed consent should always be obtained for any invasive procedure. Discussion with the patient should include indications, potential risks, complications and side effects, alternatives, and potential outcomes from the injection procedure.
Patients should sign documentation that informed consent for the procedure was given and understood. A third party should witness the patient's signing. Documentation is kept as part of the patient's record. All joint and soft tissue injection or aspiration techniques should be performed wearing gloves. When injecting or aspirating a joint space, sterile technique should be used.
Non-sterile gloves can be used when injecting or aspirating soft tissue regions. Necessary equipment for joint and soft tissue injection or aspiration is listed in Table 4. The entry point for injection or aspiration should be identified. The point of entry can be marked with an impression from a thumb-nail, a needle cap, or an indelible ink pen. The important goal is to minimize risk of infection at the site. Prepare the area with an alcohol or povidone-iodine Betadine wipe.
For all intra-articular injections, sterile technique should be used. When possible, the patient should be placed in the supine position. This will help prevent or mitigate the effects of a vasovagal or syncopal episode. Palpate the soft tissue or bony landmarks. Follow the steps for site preparation. For soft tissue injections, the following modalities may be used for short-term partial anesthesia: applying ice to the skin for five to 10 minutes; applying topical vapo-coolant spray; or firmly pinching the skin for three to four seconds at the injecting site.
To prevent complications, adhere to sterile technique for all joint injections; know the location of the needle and underlying anatomy; avoid neuromuscular bundles; avoid injecting corticosteroids into the skin and subcutaneous fat; and always aspirate before injecting to prevent intravascular injection. The injection should flow easily and should not be uncomfortable to the patient.
Most pain is the result of tissue stretching and can be mitigated by injecting slowly. If there is strong resistance while injecting, the needle may be intramuscular, intratendinous, or up against bone or cartilage, and it should be repositioned. An adhesive dressing should be applied to the injection site. To minimize pain and inflammation after leaving the office, the patient should be advised to apply ice to the injection site for no longer than 15 minutes at a time, once or twice per hour , and non-steroidal anti-inflammatory agents may be used, especially for the first 24 to 48 hours.
The affected area should be rested from strenuous activity for several days after the injection because of the small possibility of local tissue tears secondary to temporarily high concentrations of steroid. This risk lessens as the steroid dissipates. Patients should be educated to look for signs of infection including erythema, warmth, or swelling at the site of injection, or systemic signs including fever and chills. The patient should keep the injection site clean and may bathe.
Already a member or subscriber? Log in. Address correspondence to Dennis A. Cardone, D. Reprints are not available from the authors. The authors indicate that they do not have any conflicts of interest. Sources of funding: none reported.
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