An exam comes before a cortisone injection or other shot

The exam finds where the ache begins

The ache can begin within the joint. Your back, an injury or a tendon can hurt in a similar way. A tendon is the firm cord between muscle and bone. The clinician will ask when the soreness began. They'll test movement and tender spots. An X-ray can help when the cause isn't clear. For a shot, ask whether ultrasound lets the clinician watch where the needle enters.

A shot in the wrong spot won't solve the ache.

Your health can change the risk

Bring every medicine you take. Mention diabetes, blood thinners, allergies, infection and planned surgery. A steroid shot can briefly raise blood sugar. A recent shot can also affect when joint replacement is done. Don't stop medicine or change a surgery date on your own, because the clinician giving the shot and your surgeon need the same facts before either advises you about care.

Give both people the dates of earlier shots.

Fast changes after a shot need a call

Some soreness after a shot can happen. Redness, warmth, swelling or severe pain that quickly grows shouldn't be watched for days. Fever or a joint that suddenly won't move also needs prompt care. Get the after-hours number before leaving the office. Ask which problems mean urgent care and which mean an emergency department.

Seek prompt help if you're short of breath or your calf swells.

Sources

1. In a 2-year double-blind RCT of 140 patients with symptomatic knee OA and ultrasound synovitis, 40 mg intra-articular triamcinolone every 12 weeks produced significantly greater cartilage volume loss than saline (index compartment cartilage thickness change -0.21 mm vs -0.10 mm; between-group difference -0.11 mm, 95% CI -0.20 to -0.03) with no significant difference in knee pain.

   McAlindon TE, et al. — Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial.. JAMA, 2017. DOI: 10.1001/jama.2017.5283.

2. A 2-year double-blind RCT of triamcinolone every 3 months versus saline found NO difference in joint space loss between groups and significantly improved pain and stiffness with repeated steroid injections, and the authors concluded that long-term intra-articular steroid injection is safe for the anatomical structure of the knee.

   Raynauld JP, et al. — Safety and efficacy of long-term intraarticular steroid injections in osteoarthritis of the knee: a randomized, double-blind, placebo-controlled trial.. Arthritis Rheum, 2003. DOI: 10.1002/art.10777.

3. A clinical review of peripheral joint injections frames them as a treatment for joint-mediated pain (arthritis, tendinopathy, bursitis) that has NOT responded to conservative management, and states plainly that these injections are typically not curative - their objective is to reduce pain enough to allow physical and pharmacologic rehabilitation to work.

   Marcolina A, et al. — Peripheral Joint Injections.. Phys Med Rehabil Clin N Am, 2022. DOI: 10.1016/j.pmr.2022.01.005.

4. A 2024 AJR review of corticosteroid injection side effects lists local effects (post-injection flare, skin hypopigmentation and atrophy, infection, tendon rupture, accelerated osteoarthritis progression, osseous injury) and systemic effects (adrenal suppression, facial flushing, hypertension, hyperglycaemia, osteoporosis), and calls for targeted pre-injection counselling for specific populations.

   Kamel SI, et al. — Local and Systemic Side Effects of Corticosteroid Injections for Musculoskeletal Indications.. AJR Am J Roentgenol, 2024. DOI: 10.2214/AJR.23.30458.

5. A review of ten studies found single local corticosteroid injections caused a significant but TRANSIENT rise in blood glucose in patients with diabetes, with no adverse reactions or complications reported, and concluded such injections are most likely safe in people whose diabetes is well controlled.

   Waterbrook AL, et al. — Blood Glucose Levels After Local Musculoskeletal Steroid Injections in Patients With Diabetes Mellitus: A Clinical Review.. Sports Health, 2017. DOI: 10.1177/1941738117702585.

6. A meta-analysis found ipsilateral intra-articular corticosteroid injection within 3 months BEFORE joint arthroplasty was associated with increased periprosthetic joint infection risk, and the authors recommend against performing arthroplasty on a joint injected within that window - while injections given at any time overall showed no such association.

   Lai Q, et al. — Prior Intra-articular Corticosteroid Injection Within 3 Months May Increase the Risk of Deep Infection in Subsequent Joint Arthroplasty: A Meta-analysis.. Clin Orthop Relat Res, 2022. DOI: 10.1097/CORR.0000000000002055.

7. A 2017 MMWR outbreak report describes 41 cases of septic arthritis following intra-articular injections given during 250 patient visits at a single New Jersey outpatient practice, 30 (73%) of whom needed surgery; recovered organisms were oral flora and the investigation found multiple breaches of infection-prevention practice.

   Ross K, et al. — Outbreak of Septic Arthritis Associated with Intra-Articular Injections at an Outpatient Practice - New Jersey, 2017.. MMWR Morb Mortal Wkly Rep, 2017. DOI: 10.15585/mmwr.mm6629a3.