Corticosteroid Injection (Joint Injection)

Overview

A corticosteroid injection into a joint or nearby soft tissue may be used to reduce inflammation and pain from conditions such as arthritis, bursitis, or tendon irritation. The procedure typically involves placing a needle into the target area, sometimes with ultrasound or X-ray guidance, and injecting a corticosteroid that can be combined with a local anesthetic. Symptom relief can often begin within days and may span weeks to months, although response can vary by diagnosis, joint, and severity. The procedure generally aims to improve comfort and function while other treatments (such as activity modification and physical therapy) are used or considered.

Indications

This procedure may be considered when:

• •Osteoarthritis-related joint pain and inflammation (commonly knee, hip, shoulder) when symptoms can remain limiting despite conservative care
• •Inflammatory arthritis flares (such as rheumatoid arthritis) affecting a specific joint
• •Bursitis (such as subacromial bursitis in the shoulder or trochanteric bursitis at the hip) with persistent pain
• •Tendinopathy or tenosynovitis where a clinician may consider targeted injection to reduce local inflammation (for example, trigger finger)
• •Synovitis or joint effusion where aspiration and injection may be used for symptom relief and evaluation
• •Crystal-associated arthritis (such as gout or pseudogout) in selected situations where local therapy may be considered
• •Adhesive capsulitis (frozen shoulder) where injection may be used to reduce pain and facilitate rehabilitation

How It Works

The procedure typically involves several coordinated steps:

• •The clinician may select a corticosteroid formulation (for example, triamcinolone or methylprednisolone) based on joint size, diagnosis, and local practice patterns.
• •A local anesthetic (such as lidocaine) may be prepared separately or mixed with the corticosteroid to provide short-term numbing and to help confirm intra-articular placement by immediate symptom change.
• •Sterile technique is typically used to reduce bacterial inoculation risk, including antiseptic skin preparation and sterile equipment.
• •Needle gauge and length can be chosen based on depth and target (for example, larger joints may require longer needles; small joints may use finer needles).
• •Imaging guidance may be used to improve accuracy, particularly for deep joints (such as hip) or when anatomy is altered by prior surgery or body habitus.
• •If aspiration is performed, synovial fluid may be collected and can be sent for cell count, crystal analysis, and culture when infection or crystal disease is a concern.
• •The medication is typically injected into the joint space or targeted periarticular structure; corticosteroids may reduce local inflammatory mediator activity and immune cell signaling within synovium and surrounding tissues.
• •Local anesthetic effects can occur quickly and may span hours, while corticosteroid anti-inflammatory effects may begin over 24–72 hours and can vary by individual and condition.
• •Post-injection, the clinician may reassess range of motion and pain and may document response to support future treatment planning.
• •The injection site is typically covered with a small dressing, and the patient may be monitored briefly for immediate adverse effects such as dizziness, flushing, or allergic-type reactions.

Risks

As with any surgical procedure, potential risks include:

• •Infection (septic arthritis or soft-tissue infection), which can be uncommon but may be serious and can require urgent evaluation and treatment
• •Post-injection flare, where pain and swelling can temporarily worsen for 24–48 hours due to local irritation or crystal reaction
• •Bleeding or bruising at the injection site, which may be more likely in people with bleeding disorders or those using anticoagulant medications
• •Transient increases in blood glucose, which can occur in people with diabetes and may span several days
• •Skin and soft-tissue changes near the injection site, including skin thinning, depigmentation, or subcutaneous fat atrophy
• •Tendon weakening or rupture when corticosteroid is injected into or very near a tendon, particularly with repeated injections in the same region
• •Cartilage effects with repeated intra-articular corticosteroid exposure, where some studies suggest potential cartilage thinning in certain contexts
• •Allergic or sensitivity reactions to injected medications or antiseptics, which can range from mild rash to more significant reactions
• •Vasovagal reaction (lightheadedness or fainting) during or shortly after the injection
• •Temporary facial flushing or mood/sleep changes, which can occur after corticosteroid exposure and may span 1–2 days

Recovery Expectations

Recovery follows a gradual progression:

• •Immediately to same day: Mild soreness at the injection site can occur, and brief observation may span several minutes to ensure stability after the procedure.
• •First 24–48 hours: A post-injection flare may occur, and discomfort can typically span 1–2 days before improving.
• •First 1–3 days: Local anesthetic effects may last hours, while corticosteroid effects may begin over 24–72 hours depending on formulation and condition.
• •First week: Many people can often resume usual daily activities as tolerated, although higher-impact activity limitations may be suggested based on joint and diagnosis.
• •Weeks 1–6: Symptom relief may be most noticeable during this span for some conditions, and functional gains may support participation in rehabilitation or physical therapy plans.
• •Weeks to months: Duration of benefit can vary widely and may span several weeks to several months; recurrence of symptoms can occur as inflammation returns.
• •Follow-up span: Clinical reassessment may occur within several weeks to evaluate response, consider additional diagnostics, or adjust the overall treatment plan.

Alternatives

Depending on individual circumstances, alternatives may include:

• •Activity modification and structured physical therapy or supervised exercise programs
• •Oral or topical nonsteroidal anti-inflammatory drugs (NSAIDs) when appropriate, and other non-opioid analgesics
• •Joint aspiration without corticosteroid injection when diagnostic evaluation is the primary goal
• •Hyaluronic acid (viscosupplementation) injections for selected osteoarthritis cases, depending on joint and local practice
• •Platelet-rich plasma (PRP) or other orthobiologic injections in selected conditions, noting variable evidence and protocols
• •Bracing, assistive devices, or orthotics to reduce joint load and improve function
• •Surgical options for underlying structural disease (for example, arthroscopy in selected cases, or joint replacement for advanced osteoarthritis)

Sources

• AAOS OrthoInfo - Cortisone Shot (Steroid Injection)
• Mayo Clinic - Cortisone shots
• Cleveland Clinic - Cortisone Shots (Steroid Injections)
• MedlinePlus (NIH) - Joint aspiration and injection (overview and related concepts)