Image Guided Joint Injection

What is an image guided joint injection?

An image guided joint injection is used to try to partially or completely relieve pain and swelling in a joint. You will get an injection (shot) of an anesthetic, a steroid or both into the joint that is bothering you. You may have a special dye used for x-rays injected as well. Either low-dose x-rays or ultrasound pictures are used to find the exact location for the injection.

X-rays or ultrasound pictures will be taken to help your doctor locate where the needle should enter the skin. This spot will be cleaned and marked. The doctor will inject local anesthesia to numb your skin. Then, a small amount of x-ray dye or anesthesia will be injected. This makes the x-ray or ultrasound pictures clearer helping make sure that we are in the correct spot.  Next, if ordered by your doctor, the steroid will be injected into your joint. This may cause some mild pain.   

Why do I need an image guided joint injection?

These injections may be used to:

  • relieve pain from some medical conditions (arthritis).
  • manage pain before surgery.
  • manage pain if you are not medically able to have surgery.

What do I need to do before the image guided joint injection?

Continue taking all of your medications unless your health care team gives you different instructions. On the day of the injection, take any medications with small sips of water. It is okay to keep taking blood thinners (Coumadin®, Heparin®, Lovenox®, Ticlid®, Plavix®).

Tell your health care team if you are allergic to x-ray dye or iodine. It is also important to tell your health care team if you have kidney problems, diabetes and/or if you are pregnant.

What happens after the injection?

After you get the injection, you will be taken to the recovery area. You will be able leave the hospital as soon as you can stand and walk.

Note: It is best to have someone with you to help you get home.

Before you leave, we will give you written instructions about how to take care of yourself when you get home and about any follow-up appointments. We will give you a pain log and show you how to fill it out. It is important to keep track of your pain for 1week after your injection. Bring the log with you to your follow-up appointment. By looking at your pain log, your health care team can see if the injection is working.

What should I do when I get home?

It is important to drink a lot of fluids. If dye was injected during the procedure, it does not stay in your body. You will get rid of the dye when you urinate (pee). The more you drink, the faster this will happen.

Keep the injection site clean and dry for at least 24 hours. There will be a bandage over the area where you had the injections. You can remove the bandage after 2-3 days if it does not fall off on its own. The site may be sore. You can use either ice-packs or heat -packs to help with the pain. You may also take Tylenol® or any NSAID (non-steroidal anti-inflammatory agent) such as Motrin®, Naprosyn®, Alleve®, Celebrex®, Vioxx® or Bextra®. Ask your health care team how much you can take and how often.

Remember, you had anesthesia injected in your joint. This means you may still be numb and not feel joint pain. The anesthesia should wear off in 1- 6 hours. Pain you felt before your joint injection may return and could be slightly worse for a short time.

If a steroid was injected, it usually begins to work 2-3 days after the injection. It may take as long as 1-2 weeks for the steroid to work. This will depend on which joint was injected. 

Limit activities for 1-2 days. Your health care team will give you more detailed instructions. It is important to follow these instructions even if you are no longer feeling pain. 


Steroids increase blood sugar. This may make it more difficult to control your sugar levels. If you take medication for your diabetes, this medication may not control your sugar as usual. High blood sugar can cause an infection. It is important that you check your blood sugar level more often for several weeks after your injection. If your sugar level is high, call your diabetes doctor right away.

Your doctor may need to give you medication or adjust your medication to help manage your blood sugar.

What are some side-effects of the injection?

  • Tendon or Ligament Injury

    A steroid injection may weaken tendons (which attach muscles to bones) and ligaments (which attach bones to each other) near the joint. You can easily injure tendons and ligaments during the first 2-3 days after the injection. Try not to move or use the injected joint for 2-3 days. Your health care team will give you more detailed instructions.
  • Flare Response
    Steroids may cause swelling, redness and warmth in the area they were injected. They may also cause facial flushing (red face). This will usually go away within 1 day. You may take any NSAID (non-steroidal anti-inflammatory agent) such as Motrin®, Naprosyn®, Alleve®, Celebrex®, Vioxx® or Bextra®. Ask your health care team how much you can take and how often. Ice-packs may also help lessen the swelling at the injection site.
  • Bleeding
    It is possible that the injection site will continue to bleed. This does not happen often. The bleeding should stop if you put pressure on the injection site by holding a clean towel or bandage on the site. Call your health care team right away about either heavy bleeding or light bleeding that does not stop after 1 hour.
  • Skin Changes
    The skin near the injection site may change color a month or more after your joint injection. The skin may also look and feel different. These skin changes are very rare. The chance of having skin changes depends on which joint is injected and if the injection was given close to the skin. These changes are usually permanent. They will not go away.
  • Infection
    It is possible for the injected joint to become infected. This is rare but serious. The infection would be treated with antibiotics. Tell your health care team right away if you have any pain, swelling, red skin or fever that lasts for 3 or more days after the injection.


Each injection contains only a small amount of steroids. This helps to make sure the steroids stay in and affect only the area close to the injection. This also reduces the risk of side effects. It is possible that some of the steroids will travel through your body. Large amounts of steroids may be dangerous so it is best that you do not have steroid injections more than 4 times a year.