Procedure guide
Joint injections: what to know before, during and after
The risks, benefits, alternatives and aftercare I'd go over with you before a steroid shot into a sore knee, shoulder or other joint.
The short answer
- A steroid joint injection calms inflammation inside a painful joint. For knee arthritis, relief usually lasts weeks rather than months, so it works best as a bridge that lets you do the strengthening that helps long term.
- Serious problems are rare: joint infection happens in roughly 1 in 14,000 to 77,000 injections. A short flare of soreness is more common, and people with diabetes should expect higher blood sugars for a few days.
A joint injection puts a small dose of a corticosteroid, usually mixed with a numbing medicine, directly into a painful joint. The steroid calms inflammation right where it is, without the whole-body effects of steroid pills. It's one of the most common procedures in family and sports medicine, and also one of the most misunderstood: it can work well, but it isn't a cure, and it's best used as part of a plan.
Education, not a consent form
This guide explains what a consent visit covers. It doesn't replace the conversation and signed form before your own procedure, or advice about your own joints.
What a joint injection is
The doctor finds the joint space by feel, using bony landmarks, or with an ultrasound, then injects through a thin needle. The numbing medicine often brings relief within minutes. The steroid takes a few days to start working.
| Common reasons | How it's guided | |
|---|---|---|
| Knee | Arthritis flares, swelling that limits activity | Usually by landmarks; ultrasound if the joint is hard to find |
| Shoulder joint | Frozen shoulder (adhesive capsulitis), arthritis | Ultrasound recommended for accuracy |
| Space above the shoulder joint | Impingement and rotator cuff irritation | Landmarks or ultrasound |
| Hip | Arthritis | Imaging recommended, often by a specialist |
Who it's for
- Joint pain that's keeping you from daily life, work or training, despite rest, exercise and over-the-counter medicine.
- A knee or other arthritis flare, to calm things down so you can get back to strengthening.
- Frozen shoulder, where injections help most when given early, within the first couple of months of symptoms.
- Inflammatory arthritis flares in a single joint, alongside the overall treatment plan.
An injection works best alongside physical therapy or a home exercise program, not instead of it.
Who should wait, or see a specialist
- An infection in or near the joint, or a skin infection where the needle would go. That's an absolute no.
- A fracture into the joint, or a serious allergy to the medicines used.
- Feeling sick with a fever or another infection elsewhere in the body. It's usually better to wait.
- Blood thinners or a bleeding disorder. Many people on blood thinners can still have an injection, but we'd talk it through first. Don't stop a prescribed blood thinner on your own.
- Fainting with needles. Tell me ahead of time and you can lie down for it.
- Diabetes. Not a reason to skip it, but you'll need to watch your sugars closely afterward.
Benefits and risks
Benefits
Fast relief from the numbing medicine, then a few weeks of calmer pain and swelling from the steroid. A window to restart exercise and rehab. Done in the office in a few minutes.
Common risks
Brief pain from the needle. A flare of pain, swelling or stiffness for hours to a few days in 3% to 25% of people. A few days of higher blood sugar if you have diabetes.
Less common risks
Thinning or lightening of the skin at the injection site, more likely with shots into soft tissue near the surface. Bruising or a little bleeding.
Rare risks
Joint infection, about 1 in 14,000 to 77,000 injections. An allergic reaction. With frequent repeat injections, possible faster loss of cartilage.
How often is too often?
Injections into the same joint shouldn't be repeated more often than every 3 months. In one two-year trial, knee injections given every 3 months were linked to more cartilage loss, so I save them for flares rather than a fixed schedule.
What the evidence says
For knee arthritis, a large Cochrane review found that steroid injections improved pain moderately for about 1 to 6 weeks, with no clear benefit by 6 months. Another trial found that physical therapy did better than injections at one year. That's why I think of an injection as a bridge: it quiets the joint so you can do the strengthening that helps long term.
Alternatives
- Exercise and physical therapy, the first-line treatment for most joint pain and the one with the longest-lasting benefit.
- Weight loss if it applies, which takes load off the knees and hips.
- Medicines such as acetaminophen, anti-inflammatory pills or a topical anti-inflammatory gel for the knee or hand.
- Bracing, a cane or activity changes during a flare.
- Other injections, such as hyaluronic acid or platelet-rich plasma, where the evidence is mixed.
- Doing nothing. Many flares settle on their own over weeks.
Step by step
- CheckWe review your symptoms and exam, decide together whether an injection makes sense, and you sign consent.
- PositionYou sit or lie so the joint is relaxed. For a knee, that's usually lying back with the leg straight or slightly bent.
- Find the spotThe entry point is found by feeling the bony landmarks and marked, or the joint is viewed with ultrasound.
- CleanThe skin is cleaned with an antiseptic, and gloves are worn. A cold spray can numb the skin for the needle.
- InjectA thin needle goes into the joint space, and a mix of numbing medicine and steroid goes in slowly. It takes under a minute.
- RecheckA bandage goes on, and we recheck the joint a few minutes later. Many people already feel better from the numbing medicine.
Aftercare
The short version
Take it easy on the joint for a day or two, use ice for any flare, watch for signs of infection, and get back to your exercises as the pain settles.
- The first few hours: the numbing medicine wears off, and the original pain may come back until the steroid kicks in over the next few days.
- A flare of soreness or swelling usually peaks within the first day and fades over a few days. Ice and acetaminophen or an anti-inflammatory help.
- Activity: avoid heavy loading of the joint for a day or two, then build back gradually. This is the window to start or restart your rehab.
- Diabetes: check your blood sugar more often for the next several days. The rise can last from a few hours to almost two weeks, and some people need an insulin adjustment.
- Keep the bandage on for the rest of the day.
When to call
- The joint becomes hot, red and very swollen, or the pain is getting worse after the first day or two instead of better.
- Fever or chills.
- Blood sugars running much higher than usual.
- Skin changes at the site that worry you.
Which procedures Peak Health offers in the office will be confirmed before opening. You can see the full list on the Services page, and the rest of these guides in the procedure guides library.
Sources: Creech-Organ JA, Szybist SE, Yurgil JL. Joint and soft tissue injections. American Family Physician. 2023;108(2):151–158. aafp.org. Jüni P, Hari R, Rutjes AWS, et al. Intra-articular corticosteroid for knee osteoarthritis. Cochrane Database of Systematic Reviews. 2015;(10):CD005328. doi:10.1002/14651858.CD005328.pub3. Jones TY, Kelsberg G, Safranek S. Intra-articular corticosteroid injections for osteoarthritis of the knee. American Family Physician. 2014;90(2):115–116. aafp.org. Seror P, Pluvinage P, d'Andre FL, et al. Frequency of sepsis after local corticosteroid injection. Rheumatology. 1999;38(12):1272–1274.
Join the waitlist
Peak Health is not open yet. It opens for direct primary care in Colorado Springs after Dr. Bennett's Army service ends. People on the waitlist hear first and are offered membership first.
No payment and no commitment.