Joint Injection

A joint injection is a procedure in which a doctor inserts a needle directly into a joint to deliver medicine — most often a corticosteroid (a powerful anti-inflammatory drug) or a lubricating gel — right to the source of pain.

Joints such as the knee, shoulder, hip, or ankle can become inflamed or 'dried out', causing pain and stiffness. By placing medicine exactly inside the joint space, the treatment works faster and at a much lower dose than a tablet would need. Some injections also draw fluid out of a swollen joint at the same time, which gives additional relief.

Joint injections are used when a joint is causing significant pain or reduced movement and simpler treatments such as rest, physiotherapy, or oral pain relief have not provided enough help. The most common conditions treated include:

• Osteoarthritis (wear-and-tear breakdown of joint cartilage) of the knee, hip, shoulder, or small finger joints
• Rheumatoid arthritis (an autoimmune condition where the body attacks its own joint lining) causing a flare-up in a specific joint
• Bursitis (inflammation of the small fluid-filled cushion next to a joint)
• Tendinopathy (damage or irritation of a tendon near a joint)
• Gout (a build-up of uric acid crystals inside a joint causing sudden severe pain)
• Frozen shoulder (adhesive capsulitis), where the shoulder joint capsule tightens and limits movement
• Synovitis (inflammation of the membrane lining the joint) causing persistent swelling

A joint injection is usually not suitable in certain situations. Your doctor will assess these carefully before proceeding:

• Active infection in or near the joint, or a skin infection over the injection site
• A joint that has an artificial implant (prosthetic joint) — special precautions apply
• Severe blood clotting disorders that cannot be corrected
• Known allergy to the medicines used in the injection
• Poorly controlled diabetes, because corticosteroids can temporarily raise blood sugar

Joint injection is generally a low-risk procedure when performed by a trained doctor, but like any intervention that breaks the skin, it carries some recognised risks:

• Temporary pain flare ('post-injection flare') in the hours after the injection — this usually settles within one to two days
• Skin changes around the injection site, such as thinning of the skin or lightening of skin colour, especially with repeated corticosteroid injections
• Temporary rise in blood sugar levels, particularly relevant for patients with diabetes
• Infection inside the joint (septic arthritis) — rare, but serious if it occurs
• Bleeding or bruising at the injection site
• Tendon weakening if the medicine is accidentally injected into a tendon rather than the joint space
• Allergic reaction to the injected medicine — uncommon
• In some patients, repeated corticosteroid injections over time may contribute to further cartilage thinning, so doctors usually limit how often these are given

Most joint injections do not require fasting, and patients are usually able to eat and drink normally beforehand. However, your care team will give you specific instructions based on your health and the joint being treated, so always follow their guidance.

Before the appointment, the doctor will usually review your medications. Blood thinners are sometimes paused for a short period beforehand, but this decision is made on an individual basis. It is important to mention all supplements, herbal remedies, and over-the-counter medicines you take, as some can affect bleeding or interact with the injected medicine. Smoking and alcohol do not need to be stopped for this procedure specifically, though both can slow healing generally.

Tests that may be carried out beforehand include:

• X-ray or MRI (magnetic resonance imaging, a scan that creates detailed images without radiation) to confirm the condition and plan the exact injection site
• Ultrasound (USG) to guide the needle accurately into the joint space — used in many centres, especially for deeper joints like the hip
• Blood tests if an inflammatory or rheumatic condition is being monitored
• Blood sugar check for patients with diabetes

What typically happens during the procedure:

• 1. You are positioned comfortably on a treatment table with the target joint accessible.
• 2. The skin over the joint is cleaned thoroughly with an antiseptic (germ-killing) solution.
• 3. A local anaesthetic (numbing medicine) may be applied to the skin or injected just under the surface to reduce discomfort.
• 4. The doctor inserts a fine needle into the joint space. If USG guidance is used, the doctor watches a live screen to place the needle precisely.
• 5. If there is excess fluid in the joint, it may be drawn out (aspirated) through the needle first.
• 6. The medicine is slowly injected into the joint.
• 7. The needle is removed and a small dressing is placed over the site.
• 8. You rest briefly in the clinic while the team checks that you are comfortable before you leave.

Most patients go home on the same day, often within an hour of the injection. Some initial soreness around the injection site is normal and usually settles within a day or two. The full benefit of the medicine — especially with a corticosteroid — may take several days to become noticeable, so it is worth giving it time before judging whether it has helped.

• Rest the treated joint for the remainder of the day; avoid strenuous activity or heavy loading of that joint for at least 24 to 48 hours, as your care team advises
• Keep the small dressing over the injection site clean and dry; it can usually be removed after a day
• Watch for signs of infection — increasing redness, warmth, swelling, or fever — and contact your doctor promptly if these appear, as joint infection requires urgent treatment
• Patients with diabetes should monitor their blood sugar more closely in the days following a corticosteroid injection, as levels can rise temporarily
• Driving ability may be reduced if a local anaesthetic was used; arrange for someone to take you home if needed
• A follow-up appointment is usually scheduled after a few weeks so the doctor can assess how well the joint has responded and decide whether further treatment — such as physiotherapy or another injection — is needed
• If corticosteroid injections are part of a longer-term plan, the doctor will discuss how frequently they can safely be repeated, as there is usually a recommended gap between injections to protect the joint
• Physiotherapy or a home exercise programme is often recommended alongside injections to strengthen the muscles around the joint and support lasting improvement