Pain Medicine

Joint, Muscle and Spinal Injections


What is a joint injection?


A joint injection is an injection of a steroid or other medication into a joint; any place two bones move against each other and are surrounded by a joint capsule.

What is the purpose of a joint injection?


The medication injected, usually a steroid, is meant to reduce the inflammation and/or swelling of tissue in the joint space. This may in turn reduce pain, and other symptoms caused by inflammation or irritation of the joint and surrounding structures.


How long does the joint injection take?


The actual injection takes only a few minutes.


What is actually injected?


The injection typically consists of a local anesthetic and a low dose steroid medication.

Will the joint injection hurt?


The procedure involves inserting a needle through skin and deeper tissues. So, there is some minor discomfort involved. However, we sometimes numb the skin and deeper tissues with a local anesthetic using a very thin needle before inserting the needle into the joint. This technique makes this procedure very comfortable for most of our patients.

Will I be “put out” for the joint injection?


No. This procedure is done with a small gauge needle usually with or without any local anesthetic.

How is the joint injection performed?


It is done with the patient in whatever position allows the best access into the joint. Shoulders, elbows, wrists, fingers and knees are often injected with the patient sitting. Hips, knees, ankles and toes are often injected with the patient lying down. The skin is cleaned with antiseptic solution and then the injection is carried out. A band-aid is usually applied.

What should I expect after the joint injection?


Immediately after the injection, you may feel that your pain may be gone or quite less. This is due to the local anesthetic injected. This will last only for a few hours. Your pain will return and you may have a sore joint for a day or two. This is due to the mechanical process of needle insertion as well as initial irritation from the steroid itself. You should start noticing pain relief starting the 3rd to 5th day or so.

What should I do after the joint injection?


You may want to have a ride home. We advise the patients to take it easy for a day or so after the procedure. You may want to apply ice to the affected area. Perform the activities as tolerated by you.

Can I go to work to work the next day?


Unless there are complications, you should be able to return to work the next day. The most common thing you may feel is sore joint.

How long does the effect of the medication last?


The immediate effect is usually from the local anesthetic injected. This wears off in a few hours. The cortisone starts working in about 3 to 5 days and its effect can last for several days to a few months.

How many joint injections do I need to have?


If the first injection does not relieve your symptoms in two to three weeks, you may be recommended to have one more injection. If you respond to the injections and still have residual pain, you may be recommended for further injections on an as needed basis, depending on the underlying condition of the joint.

Will the joint injections help me?


It is sometimes difficult to predict if the injection will indeed help you or not. The patients who have recent onset of pain or milder pain may respond much better than the ones with a longstanding pain or severe pain.

What are the risks and side effects of joint injections?


Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects and possibility of complications. The most common side effect is pain – which is temporary. The other risks involve, infection, bleeding, worsening of symptoms etc. The other risks are related to the side effects of steroids: These include weight gain, increase in blood sugar (mainly in diabetics), water retention, suppression of body’s own natural production of cortisone etc. Fortunately, the serious side effects and complications are uncommon.

Who should not have a joint injection?


If you are allergic to any of the medications to be injected, if you are on a blood thinning medication, if you have an active infection going on, or if you have poorly controlled diabetes or heart disease, you should not have a joint injection or at least consider postponing it if postponing would improve your overall medical condition.

Trigger Point Injection


What is trigger point?


Trigger points are tender muscles that sent a pattern of pain to other areas of the body when palpates or touched. These tender points are usually felt as knots or bands. Trigger points can be localized to one area or the body such as the muscles that support the neck. They can also occur in multiple areas throughout the entire body.


What causes trigger points?


Trigger points can become problematic for a number of reasons. Patients may develop trigger points because of injury to muscle tissue. Examples of muscular injury include whiplash, overuse of a muscle group, repetitive movements, or a post-viral syndrome. Trigger points may also occur because of an underlying structural problems. Spinal abnormalities such as herniated and degenerative discs, scoliosis, postural problems, and osteoarthritis are examples of conditions commonly associated with trigger points.


What is a trigger point injection?


A trigger point injection is an injection of a substance into a tender muscle. Examples of substances injected include local anesthetics, corticosteroids, Ketorolac, saline solution, and dextrose.


What is the effect of injecting local anesthetics and Anti-inflammatory medications?


Local anesthetics act to increase blood flow by dilating blood vessels in the muscle. This helps to rid the muscle of inflammatory substances that accumulate when muscles go into spasm. Corticosteroids are anti-inflammatories. These medications help to block inflammation. Inflammatory substances in the muscle produce pain by sensitizing nerve endings and receptors. In addition, the physical force of the fluid helps to break muscle spasm and adhesions.


Are there any side effects associated with trigger point injections?


Trigger point injections are very safe. patients may feel some injection site tenderness following the infection as the local anesthetic wears off. it may take a few days for the anti-inflammatory action of the steroid to take effect. Patients will sometimes feel a little dizzy for up to an hour if multiple trigger points are injected with a large dose of local anesthetic.


How long does the pain relief last?


A definitive answer is not possible because it depends on the nature of the patient's condition. The local anesthetic will numb the area for 1 to 3 hours. The corticosteroids remain in the tissue in active form for about one month. The major benefit of trigger point injections is to allow the patient to move effectively so he/she can participate in a rehabilitative program. Trigger point injections loosen muscle groups thereby improving patient progress in physical therapy and joint mobilization.


What if trigger point injections do not help to reduce my pain?


If trigger point injections are not effective in reducing your pain, other modalities are available (such as medical management, nerve blocks, electrical stimulation techniques, intradiscal techniques, and radiofrequency) to control pain depending on your condition.

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