Preparation
How would you go about consenting a patient for a joint injection?
Think about the indications, contraindications, risks, and benefits when consenting a patient for any procedure.
Most physicians obtain the consent verbally and include it in their procedure note.
Now that you are ready to proceed, which steroid should you use, and how much?
There are many preparations of injectable steroids. Steroids vary based on their potency and half-lives. There is no data to support one type of steroid's efficacy over another.
Most clinics will carry one or two different types, which will narrow down your decision. You should try to learn those preparations well.
It is often easier to remember a generalized amount of steroid for each joint, rather than a specific steroid preparation.
Four commonly used steroids are listed on this page to guide your decision.
Injection Kit Tools
Some clinics will provide you with sterile, pre-made injection kits, but you can always assemble your own. What supplies will you need to gather before performing a joint injection?
See how many you can list.
Povidone-iodine or alcohol swabs
Gloves (sterile or non-sterile)
5-20cc syringe
22- to 25-gauge, 1.5-inch needle
16- to 18-gauge, 1-inch needle
Band-aid or sterile 4x4 gauze pads
Steroid or hyaluronic acid preparation
1 or 2% lidocaine or marcaine w/o epinephrine or parabens preservative*
Ethyl chloride spray (optional)
Sterile drapes (optional)
Skin marker (optional)
*Parabens is a preservative often used in multi-dose vials of lidocaine. When parabens interacts with steroids, a precipitate can form and cause an undesirably longer half-life of the steroid within the joint space. It is unclear what the clinical relevance of this is, but single-dose vials are recommended when available.
In this image: Equipment needed for a joint injection.
What about the skin prep, and should you use sterile or non-sterile gloves?
There is no consensus on using alcohol or iodine as a skin prep. It is acceptable to use either one; however, it is common to cleanse the skin with iodine prior to an intra-articular injection compared to a soft tissue injection.
Again, there is no evidence for improved outcomes if an injection is performed under sterile conditions; however, most practitioners wear sterile gloves and try to maintain a sterile field during the procedure.
What might you add if you were planning to aspirate too?
A bigger syringe (10-50cc), depending on the estimated size of the effusion lab and culture tubes, if clinically indicated sterile hemostat to steady the needle hub (optional).