JOINT, TENDON, LIGAMENT INJECTIONS

FREQUENTLY ASKED QUESTIONS

  • What are Steroid Injections?

  • Am I a Candidate for an Injection?

  • What Structures can be Treated with Steroid Injections?

  • Are these Injections Painful?

  • Can I have any Type of Sedation for these Procedures?

  • Will an Injection make all my Pain go Away?

  • How Long will it take to get Pain Relief after an Injection?

  • How Long will Pain Relief last after an Injection?

  • How Many Injections will I Need?

  • What if the Injection does not Help my Pain?

  • What are the Risks of an Injection?

  • What are the Side Effects of Steroid Medications?

  • Does Insurance Cover this Injection?

  • What Should I do After the Injection?

 

What are Steroid Injections?

  • Steroids are powerful anti-inflammatory medications.

  • Steroids are used for many conditions associated with inflammation such as arthritis, bursitis, tendinitis, etc.

  • Steroids injections are commonly referred to as “Cortisone Injections.”

  • These Steroids are not the same type of steroids used by people to gain muscle.

    • These steroid medications refer to Corticosteroids, which are used only for their anti-inflammatory benefits.

  • Injections using Regenerative Medications (Platelet Rich Plasma, Stem Cells)

    • These treatments may help regenerate damage of a joint, ligament, tendon, cartilage, etc.

    • This may possibly fix the cause of inflammation, not just treat symptoms.

    • See the specific pages on Regenerative Medicine for more details.

 

Am I a Candidate for an Injection?

  • There are no exact criteria needed to be considered a candidate for a steroid injection.

    • However, there are usually some suggested criteria.

  • Usually, patients should have first tried (and failed to improve) with appropriate conservative measures.

    • Examples: NSAIDs, Physical Therapy, Chiropractic Care, Massage, Acupuncture etc.

    • Conservative measures depend on the patient and the condition being treated.

    • Injections are not usually deemed to be a first line treatment for most conditions.

  • Most candidates will need some form of imaging (x-ray, MRI) to confirm the diagnosis.

    • If the issue is predominantly inflammatory, steroids can provide great benefit.

    • In some cases, steroids medications may make the condition worse.

      • For instance, a tendon tear may become worse with steroid medications.

      • Steroid can weaken tissue making tears worse over time.

 

What Structures can be Treated with Steroid Injections?

  • Shoulder

    • Joint Pain

      • Glenohumeral Joint Arthritis: Joint connects the Shoulder Bone to the Arm Bone

      • Acromioclavicular Joint Arthritis: Joint connects the Collar Bone to the Shoulder Blade Bone

      • Shoulder Labral Tear: Cartilage on the Interior Socket of the Shoulder

    • Ligament Pain

      • Shoulder Ligament Sprains: Help to Stabilize the Shoulder Joint

    • Tendon Pain

      • Rotator Cuff Tendon Tear/Tendinitis

      • Biceps Tendon Tear/Tendinitis

    • Bursa Pain

      • Subacromial Bursitis: Bursa between the Shoulder and Rotator Cuff Muscles

  • Elbow

    • Joint Pain

      • Elbow Joint Arthritis: Joint connects the Arm Bone to the Forearm Bone

    • Ligament Pain

      • Ulnar Collateral Ligament Injuries: Help to Stabilize the Elbow Joint

    • Tendon Pain

      • Lateral Epicondylitis: Tennis Elbow

      • Lateral Epicondyle Tendon Tear

      • Medial Epicondylitis: Golfers Elbow

      • Medial Epicondyle Tendon Tear

    • Bursa Pain

      • Olecranon Bursitis: Bursa on the back of the Elbow

    • Nerve Injury

      • Ulnar Nerve Injury

  • Hand/Wrist

    • Joint Pain

      • Wrist/Finger Joint Arthritis: Numerous Joints

    • Ligament Pain

      • Wrist/Finger Ligament Sprain: Help to Stabilize the Wrist and Finger Joints

    • Tendon Pain

      • Wrist/Finger Tendon Tear/Tendinitis

    • Nerve Injury

      • Carpal Tunnel Syndrome

  • Hip/Pelvis

    • Joint Pain

      • Hip Joint Arthritis: Joint connects the Hip Bone to the Leg Bone

      • Hip Joint Labral Tear: Cartilage on the Interior Socket of the Hip

      • Pubic Symphysis Pain: Joint located in the Front of the Pelvis

    • Ligament Pain

      • Iliotibial Band Syndrome: Runs along the Outside of the Thigh from Hip to Knee

      • Hip Ligament Sprain: Help to Stabilize the Hip Joint

    • Tendon Pain

      • Piriformis Syndrome/Tendonitis

      • Quadricep Tendon Tear/Tendonitis

      • Hamstring Tendon Tear/Tendinitis

      • Iliopsoas Tendon Tear/Tendinitis

      • Gluteal Tendon Tear/Tendinitis

    • Bursa Pain

      • Trochanteric Bursitis: Bursa on the outside of the Hip

      • Ischial Bursitis: Bursa on the back of the hip at the Hamstring Tendons

      • Iliopsoas Bursitis: Bursa on the front of the hip at the Hip Flexor Tendons

    • Nerve Injury

      • Sciatic Nerve Injury

  • Knee

    • Joint Pain

      • Knee Joint Arthritis: Joint connects the Thigh Bone to the Lower Leg Bone

      • Knee Meniscus Tear: Cartilage Pads between the Bones of the Knee Joint

    • Ligament Pain

      • Medial/Lateral Collateral Ligament Sprains/Tears: Help to Stabilize the Knee Joint

      • Anterior Cruciate Ligament (ACL) Sprains/Tears: Promotes Stability of the Knee

      • Posterior Cruciate Ligament (PCL) Sprains/Tears: Promotes Stability of the Knee

    • Tendon Pain

      • Patella Tendon Tear/Tendinitis

      • Quadriceps Tendon Tear/Tendinitis

      • Hamstring Tendon Tear/Tendinitis

    • Bursa Pain

      • Knee Bursitis: Numerous Bursa

    • Nerve Injury

      • Peroneal Nerve Injury

  • Foot/Ankle

    • Joint Pain

      • Ankle/Foot Arthritis: Numerous Joints

    • Ligament Pain

      • Ankle Sprain: Help to Stabilize the Ankle Joint

      • Plantar Fasciitis: Help to Stabilize the Arch of the Foot

    • Tendon Pain

      • Peroneal/Posterior Tibialis Tendonitis

      • Achilles Tendon Tear/Tendinitis

    • Nerve Injury

      • Tarsal Tunnel Syndrome

 

Are these Injections Painful?

  • Most individuals tolerate injections well with little discomfort.

  • Any discomfort felt is usually short-lived and tolerable.

  • If you feel any significant discomfort during the procedure, tell your doctor.

 

Can I have any Type of Sedation for these Procedures?

  • Most patients do not require any type of anesthesia for these types of injection.

  • In some instances, such as severe pain, anesthesia may be used to make the procedure more tolerable.

    • Goal of Sedation: Reduce pain and anxiety just enough to make the procedure more comfortable

  • Local anesthetic medications can be used in the office to help reduce pain from the procedure.

    • If more sedation is required than just local numbing medication, we may consider doing the procedure in a surgical center setting.

 

Will an Injection make all my Pain go Away?

  • Goal on Injections: Reduction of pain enough to allow the individual to regain quality of life and function.

  • While it is possible to obtain complete pain relief after injections, it is not always possible.

 

How Long will it take to get Pain Relief after an Injection?

  • Most individuals start to get pain relief within 1-3 days after the steroid injection.

  • In some cases, it may take up to 7-10 days after the injection to feel any benefit.

  • Maximum improvement usually occurs around 7-14 days after the injection.

 

How Long will Pain Relief last after an Injection?

  • Everyone responds differently to steroid injections.

  • A steroid injection works by reducing inflammation.

    • Pain usually improves once inflammation decreases.

    • Pain relief often lasts as long as the inflammation remains controlled.

  • Injections are basically “Band-Aids” designed to treat symptoms due to inflammation.

    • Injections do not heal/remove the actual cause of the inflammation.

    • However, if the pain goes away for a long time, injections can be a great Band-Aid.

  • Pain has potential to return in the future if the inflammation returns.

    • If inflammation returns quickly after an injection, pain may also return quickly.

    • If inflammation never returns, pain may resolve forever as well.

  • A “Good Response” to an injection is considered at least 3-4 months of significant pain relief.

    • If symptoms return, it may be appropriate to perform another injection.

  • Medications, exercise and/or physical therapy can often enhance/prolong the benefit of an injection.

 

How Many Injections will I Need?

  • Number of injections needed depends on the response to the injections.

  • If the injection provides significant benefit, then no more injections are needed.

    • If the injection helps, but some pain remains, a second injection may provide “additive” benefit.

  • Even if the injection helps reduce pain significantly, pain may return again in the future.

    • If this occurs, it may be necessary to repeat the injections again.

  • Steroid medications and injections are not without risk.

    • We recommend limiting the number of steroid injections to no more than 3-4 injections per body region per year.

    • As with any medical treatment, the minimal number of injections needed to have the desired effect is recommended.

 

What if the Injection does not Help my Pain?

  • Possible reasons why an injection may not have helped reduce pain:

    • Some require more than one injection to get adequate pain relief.

    • Sometimes pain is not due to inflammation (injections work better when pain is due to inflammation).

    • There may be another cause of pain.

      • There may be more than one issue causing pain.

    • Individuals with severe disease/tears may not respond well to injections.

      • Sometimes, more aggressive treatments, such as surgery, are the best treatment options.

  • If the injection does not help your pain, your provider will discuss other treatment options.

 

What are the Risks of an Injection?

  • All injections have possible risks, side effects, and complications.

    • When performed correctly, all the following risks are rare.

  • PAIN

    • Injections usually do not cause significant discomfort during or after the procedure.

    • Any increased discomfort usually lasts less than 24 hours.

  • BRUISING

    • Superficial bruises resolve without any specific treatment.

    • More common in older individuals and those taking blood thinning medications.

  • INFECTION

    • Minimal risk, as we thoroughly clean the skin prior to every injection.

    • All needles are brand new (never reused) and opened just prior to the injection.

  • BLEEDING

    • Excessive bleeding is rare, even if the needle hits a deeper blood vessel.

      • Any bleeding should stop on its own without complications.

    • Risk of bleeding increases if you have a genetic bleeding disorder or if you are taking blood thinners.

  • NERVE DAMAGE, PARALYSIS

    • Very Rare Complication

    • Direct Nerve Trauma from the Needle is unlikely.

  • SEIZURES, DEATH

    • Extremely Rare Complications

 

What are the Side Effects of Steroid Medications?

  • Steroid medications have many potential side effects.

  • Steroid Injections usually cause less side effects than Steroid Pills.

    • Injections require less steroid, since the steroids are being placed directly at the site of injury.

    • Injected steroids do not require absorption through the stomach, lowering incidence of GI side effects.

  • Common Steroid Side Effects: Usually Mild and Temporary

    • Flushing of the Skin

    • Indigestion/Upset Stomach

    • Increased Appetite

    • Increased Blood Glucose Levels (See Section for Diabetic Patients)

    • Difficulty Sleeping/Insomnia

    • Increased Anxiety/Restlessness

    • Racing/Pounding Heart (Tachycardia, Palpitations)

    • Headaches

  • Rare, Severe Steroid Complications

    • Thinning of the Skin and Soft Tissue at the Injection Site

    • Weakening/Rupture of Tendons

    • Hypopigmentation (Whitening/Lightening) of the Skin around the Injection Site

    • Damage of Cartilage

    • Thinning of Bone (Osteoporosis)

    • Death of Bone (Osteonecrosis)

  • Steroids and Diabetes

    • Steroid medications will temporarily increase blood glucose levels.

    • If you use insulin, you may need to adjust your dosing temporarily.

      • Be sure to discuss this with your primary care doctor or endocrinologist.

  • To reduce risk, it is best to limit the dose of steroids.

    • Stone Med recommends limiting injections to no more than 3-4 per year.

      • Less injections mean less risk of potential complications.

    • Although it seems like common sense, steroid injections should only be used if they provide significant benefits.

      • Do not continue to get steroid injections if they do not work.

 

Does Insurance Cover this Injection?

  • Insurance typically covers in-office steroid injections, as long as there is good medical justification for their use.

  • If there is any question, we will run your benefits to ensure that the procedure is covered.

 

What Should I do After the Injection?

  • ACTIVITY

    • On the day of the injection, you may resume normal, everyday activities.

    • Try to avoid strenuous lifting/activities for about 2-3 days after the procedure.

  • MEDICATIONS

    • You may take pain medications immediately after your injection, if needed.

    • Take all your regular medications as prescribed.

  • PAIN

    • You may use an ice over the injection site, 20 minutes on, 20 minutes off, repeating as needed.

  • WATER/BATHS/SHOWER

    • You may shower the evening of your procedure, if desired.

    • Avoid submerging the injection site under water for at least 24 hours to reduce any risk of infection.

      • No Baths, No Swimming Pools, No Hot Tubs, etc.

  • CALL YOUR DOCTOR IF YOU DEVELOP ANY OF THE FOLLOWING:

    • Fever/Chills

    • Drainage/Other Signs of Infection

    • Excessive Swelling or Redness at the Injection Site

    • New/Worsening Severe Pain

    • New/Worsening Bowel/Bladder Dysfunction

    • New/Worsening Numbness/Weakness

    • New Headache that does not Resolve on its own

  • FOLLOW UP

    • Typically, you will be seen in the office about 2 weeks after the injection.

    • If you have not made a follow up appointment, please call the Stone Med office to set up this appointment.