Steroid Injections

What are steroid joint injections?

Steroids are a type of medication that can reduce inflammation, pain, and swelling in joints or soft tissue structures such as tendons.

How are steroid injections done?

Steroid injections can be administered under the guidance of ultrasound, computerized tomography (CT), or fluoroscopy, which is a type of X-ray. We always use image guidance to ensure precision and accuracy during the procedure. Before starting, we mark the site of injection on the skin after visualizing it on ultrasound, CT, or X-ray. To maintain sterility, we clean and numb the skin before inserting the needle into the area of injury. Once we confirm that the needle is in the exact location, we inject the steroid typically mixed with some local anesthetic.

Where can you inject?

We can administer injections to various joints, bursae, cysts, ligaments, and tendons, including the shoulder, hip, knee, elbow, wrist, hand, ankle, and foot.

What happens during the procedure?

During the exam, you will be asked to lie down on an exam table or bed and will be positioned to allow best visualization of the area of injury while maintaining comfort. An ultrasound, CT, or fluoroscopy machine will be used during injections to help us see where we are. Once we have confirmed that we are in the joint, we will typically inject two medicines: a steroid (usually Kenalog), and a long-acting anesthetic called ropivacaine. The steroid helps to decrease inflammation in the area we are injecting, which reduces pain. The ropivacaine is used to alleviate pain and confirm that the source of pain is indeed originating from the area being injected. The steroid usually starts to work within 2-3 days, with the full effect taking about a week or two.

What are the risks of a steroid injection?

This is a low-risk procedure. You may experience some minimal discomfort and swelling in the skin after the procedure. However, as with any procedure involving a break in the skin, there is a slight risk of bleeding or infection. Nevertheless, we use a sterile technique and ensure everything is clean to minimize the risk of such occurrences. Overall, the risk is very low. In a few patients, steroids will significantly increase pain for several days after injection due to what is called a cortisone flare, which is believed to be caused by crystals in the steroid preparation increasing inflammation at the injection site. Steroids can cause atrophy, or shrinking, of soft tissues at the injection site, which can increase the risk of soft tissue tearing in the area of injection. This atrophy may also result in thinning or discoloration of the skin overlying the injection site, which is usually temporary but may take several months to resolve.

What does the patient need to do to prepare?

Before the procedure, please inform us if you are taking any blood thinners or if you have any allergies to medication. If you are diabetic, please be aware that steroids can increase your blood sugar levels for a few days. Patients do not need to fast before this procedure.

Post-Procedure Care

  • The local anesthetic effect typically lasts 4–6 hours.
  • It is common to experience mild soreness at the injection site(s) for 24–48 hours. Ice is the best remedy. You may apply ice for 20 minutes at a time, several times a day, as needed. Place the ice pack over a towel or clothing to prevent skin injury.
  • For the next 48 hours, do not put anything on your skin where the injection site is, including creams, lotions, sprays, and gels.
  • For the next 48 hours, do not submerge the body part that was injected into a pool or bathtub. A regular shower is OK.
  • Please remove the sterile dressing or band-aid tonight or tomorrow morning. Do not leave it on after you have taken a shower or if you have gotten it wet.
  • Corticosteroid side effects can occur after this injection but usually resolve after several days. These side effects can include flushing, hot flashes, mild palpitations, insomnia, water retention, feeling anxious or restless, or headaches.
  • While it is extremely rare to get an infection after joint injections, if you develop any signs of infection, please call the office. These signs include fevers or chills, severe increased pain, redness/warmth at the injection site, or any drainage from the injection site.
  • Remember that the corticosteroid benefit (long-term pain relief) from an injection can take as long as 10 to 14 days to occur. You may have a period of slightly increased pain after your injection before the cortisone takes effect.
  • The benefit of the steroid typically lasts 2-3 months, but may last significantly longer.
  • You may resume all your normal daily activities 1-2 days after your injection.

How often do I need to come back?

You can get injections every 3 months; however, it is not required! Consult with your orthopedic doctor to see what your next steps will be.

For questions and/or concerns you may contact our radiology team, Mon-Fri, 8 am-5 pm at 713-500-XRAY (9729).


  1. Chakravarty K, Pharoah PD, Scott DG. A randomized controlled study of post-injection rest following intra-articular steroid therapy for knee synovitis. Br J Rheumatol. 1994 May;33(5):464-8. doi: 10.1093/rheumatology/33.5.464. PMID: 8173852.
  2. Intra-articular Corticosteroid Injections for the Treatment of Hip and Knee Osteoarthritis-related Pain: Considerations and Controversies with a Focus on Imaging—Radiology Scientific Expert Panel Ali Guermazi, Tuhina Neogi, Jeffrey N. Katz, C. Kent Kwoh, Philip G. Conaghan, David T. Felson, and Frank W. Roemer, Radiology 2020 297:3, 503-512