| Because we develop arthritis of various joints in the body, at times it is necessary to inject a small amount of steroid into the joint to provide comfort and reduction in pain. While repeated steroid injections into joints can cause long term problems, it is not clear that short term intermittent injections pose the same risks. INDICATIONS: Severe intractable pain in the joints or in the bursal lubricating sacs around the joint. These injections provide transient relief from severe pain by the steroid anti-inflammatory effect. SPECIFIC JOINTS AND BURSAE: The trochanteric bursa are frequently a cause of lateral thigh pain, especially at night and during prolonged walking. The bursa sac is normally filled with lubricating fluid but an inflamed bursa can cause severe pain. Injections of steroids into the bursa can provide instant relief from severe pain, and subsequent physical therapy helps avoid recurrence. Olecranon bursitis is a swelling at the tip of the elbow which may be treated with an in-office injection of steroids. It usually resolves relatively quickly. Other sites of bursitis which are amenable to injections include the shoulder (subacromial bursa), knee (prepatellar and infrapatellar bursae), buttocks (ischeal bursa), etc. Joint injections may be performed using a small needle and with or without fluoroscopy depending on the joint. The most common injected joints include the knee, hip, wrist, shoulder. These should be limited in number in a given joint due to the possibility of long term cartilage damage. Other than the risk of damage to the joint from repeated injections, steroid injections are relatively safe having an extremely low rate of infections. Some series have 1:10,000 risk of infection. |
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