Upper and Lower Extremity Steroid Injections and Arthrograms
Drs. Walz and Coopersmith perform joint, bursa and tendon sheath injection throughout the musculoskeletal system. A full list is provided below along with patient instructions.
- Shoulder, AC Joint, Subacromial Bursa, Biceps Tendon Sheath
- Small joints of the hand and wrist
- Hip, Iliopsaos Bursa, Ischial Tuberosity, Greater Trochanteric Bursa
- Small joints of the foot and ankle
- Foot and ankle tendon sheaths
Your doctor has referred you for an arthrogram or joint injection. This procedure is often performed as a means of injecting steroids (cortisone) into a joint by image guidance. It can also be performed to inject MRI dye (gadolinium) in preparation for an MRI arthrogram.
If you are on blood-thinners, you should make the radiologist aware. Arthrograms can typically be performed even in patients on blood thinners but may require further testing. It is important to notify the radiologist of allergies such as to x-ray dye, iodine, lidocaine or steroids. The risks of the procedure include allergy, infection, temporary increased pain and bleeding. These are all rare and will be explained to you by the radiologist before the procedure.
The basic procedure for all arthrograms is the same regardless of the joint being injected. You will be placed on a fluoroscopy or x-ray table and the part of your body to be injected will be exposed. Using fluoroscopy/x-rays as a guide, a mark will be placed on your skin and this area will then be cleaned and draped for the procedure. After the area is cleaned, local anesthesia (lidocaine/novacaine) will be injected into the skin to numb the area. The needle for the injection will then be placed into the joint. At this point, unless you are allergic, x-ray dye will be injected into the joint to confirm correct placement. Once this is confirmed, a mixture of steroid and pain medication will be injected. The needle will then be removed and a band-aid placed on your skin.
If the joint injection is performed as part of an MRI arthrogram, MRI dye (gadolinium) will be injected into the joint possibly mixed with steroid and pain medication as per your doctors request. After the injection, you will be transferred to MRI for further imaging.
If the injected joint is the source of your pain, the pain medication that is injected will likely provide relief for 4-6 hours starting about 15 minutes after the procedure. The steroid tends not to work for 2-3 days but can sometimes take 5-7 days to start to provide relief. Once it starts to provide relief, this may last from 1 to 6 months. If there is no relief form the steroid or pain medication, it is unlikely that the injected joint is the source of your pain. This result can be discussed with your orthopedist. You may experience mild pain at the injection site for 24 hours which is best treated with over-the-counter pain medication and ice.
Although the risk of infection is very low, if you develop symptoms of redness or swelling at the biopsy site or fever you should call your doctor or the radiologist who performed the biopsy. If you have diabetes, a steroid injection may cause a temporary increase in your blood glucose and this should be more closely monitored during the week after the injection.