Objectives
Knowledge
Understand the indications, contraindications, risks, and benefits for performing joint injections
Learn techniques for performing injection of several common anatomic sites
Learn about medications that can be used for joint injections
Understand the potential complications of joint injections
Skills
Apply knowledge of joint injections to patient case scenarios
Risks and Complications
Post-injection flare
Facial flushing
Steroid-induced fat atrophy
Iatrogenic infection/bleeding (rare)
Transient hyperglycemia (more common in poorly controlled diabetics)
Tendon rupture (rare)
Benefits
Rapid relief of pain
Avoidance/delay of surgical intervention Inexpensive
Minimal side effects
Indications for Joint Injection/Aspiration
Consider use of joint injections when a painful joint (due to osteoarthritis or inflammatory arthritis) fails to respond to other conservative measures such as disease-modifying anti-rheumatic medications, NSAIDS and other oral pain medications, physical therapy, and weight loss
Injections can also be used for:
Diagnosis or exclusion of other causes of musculoskeletal pain
Diagnosis of septic joint or confirmation of suspected crystal-induced arthropathy (e.g., gout or pseudogout) by obtaining synovial fluid for culture or microscopy
Symptomatic relief of a large effusion
Contraindications for Therapeutic Joint Injections
Absolute:
Suspected septic joint, unless performing aspiration for diagnostic purposes
Presence of an active overlying cellulitis or broken skin
Relative:
Lack of response to previous therapeutic joint injections
Prosthetic joint
Uncontrolled coagulopathy
A specific cut-off level for INRs has not been studied, but therapeutic levels are generally acceptable
