What are joint and tendon steroid injections?
Joint and tendon injections are a form of treatment for children with arthritis or inflammation. Medications, usually a steroid called triamcinolone, are injected into the affected joints or tendons to relieve pain and swelling.
This treatment is sometimes done using image guidance (using ultrasound or X-ray) to guide a needle into the joint space or tendon sheath, so that the medication can be injected into the right place. The tendon sheath is the layer of membrane around the tendon.
Image guidance is used when the affected joints and tendons are deep inside the body or in difficult to see places. When these injections are done using image guidance they are done by an interventional radiologist.
Risks of joint and tendon injections
Joint and tendon injections are usually low-risk procedures. The risk may increase depending on your child’s condition, age and health.
The risks of any joint or tendon injections include:
- pain, swelling, bruising or bleeding of the skin or joint
- infection (serious, but very rare)
- scars, or thinning of the skin, over the injection site
- calcium build-up over the injection site
- tendon rupture (serious, but very rare)
- allergic reaction (rare)
- variable or changing response: the response may be excellent, good or poor, and it may last a short time or a long time
Giving consent before the procedure
Before the procedure, the interventional radiologist will go over how and why the procedure is done, the potential benefits as well as the potential risks. They will also discuss what will be done to reduce these risks. They will help you weigh the potential benefit of the procedure against any risk it may pose for your child. It is important that you understand all the risks and potential benefits of the joint and tendon injections and that all your questions are answered. If you agree to the procedure, you can give consent for treatment by signing the consent form. A parent or legal guardian must sign the consent form for young children. The procedure will not be done unless you give your consent.
How to prepare your child for the procedure
Before any treatment, it is important to talk to your child about what will happen. When talking to your child, use words they can understand. Let your child know that medicines will be given to make them feel comfortable during the procedure.
Children feel less anxious and scared when they know what to expect. Children also feel less worried when they see their parents are calm and supportive.
If your child becomes ill within two days before the procedure
It is important that your child is healthy on the day of their procedure. If your child starts to feel unwell or has a fever within two days before the steroid joint injections, let their health-care provider know. Your child’s procedure may need to be rescheduled.
Food, drink and medicines before the procedure
- Your child’s stomach must be empty during and after sedation or general anaesthetic.
- If your child has special needs during fasting, talk to their health-care provider to make a plan.
- Your child can take their regular morning medicine with a sip of water two hours before the procedure.
- Medicines such as acetylsalicylic acid (ASA), naproxen or ibuprofen, warfarin or enoxaparin may increase the risk of bleeding. Do not give these to your child before the procedure. If your child is taking any of these medicines, please discuss this with their health-care provider and the interventional radiologist.
On the day of the joint and tendon injections
Arrive at the hospital two hours before the planned time of your child’s procedure. Once you get there, your child will be dressed in a hospital gown, weighed and assessed by a nurse. You will also be able to speak to the interventional radiologist who will be doing the steroid injections and the anaesthetist or nurse who will be giving your child medication to make them comfortable during the procedure.
Your child will also be reassessed by their health-care provider from rheumatology to see if any more joints or tendons need to be treated.
During the joint and tendon injections, you will be asked to wait in the waiting room.
Your child will have medicine for pain
Children are given medicine for treatments that may be frightening, uncomfortable or painful. Most children will have general anaesthesia for joint and tendon injections. The type of medicine that your child will have for the procedure will depend on your child’s condition.
How are these injections done?
The interventional radiologist uses an ultrasound or X-ray to locate the joint space or tendon sheath. Once the site is located, the interventional radiologist uses the image as a guide to put a thin needle into the joint space or tendon sheath.
Through this needle the interventional radiologist will inject the steroid and some local anaesthetic.
The procedure may take anywhere from 45 minutes to two hours, depending on how many sites need to be injected.
After the joint and tendon injections
Once the joint and tendon injections are complete, your child will be moved to the recovery area. The interventional radiologist will come and talk to you about the details of the procedure. As soon as your child starts to wake up, a nurse will come and get you.
Your child may experience some mild discomfort at the treatment sites. If this happens, your child will be given pain medicine.
Going home
Most children who have joint and tendon injections go home the same day. This is usually one hour after the procedure.
For more details on how to care for your child after joint and tendon injections, please see Joint and tendon injections: Caring for your child at home after the procedure.
At SickKids
At SickKids, the interventional radiologists work in the Department of Image Guided Therapy (IGT). If you have any concerns in the first 48 hours, you can call the Image Guided Therapy (IGT) clinic at (416) 813- 7654 ext. 201804. Speak to the IGT clinic nurse during working hours or leave a non-urgent message.
For more information on fasting see Eating and drinking before surgery.
For more information on preparing your child for their procedure see Coming for surgery.