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An injection into the joint
Almost everybody is frightened of this one. The needle is usually finer than the one used for a blood test, the whole thing takes two or three minutes, and most people say afterwards that it was much less than they expected.
What people worry about
The needle will damage my joint.
It does not touch the surfaces that matter.
The needle goes into the fluid-filled space inside the joint, not into the cartilage or the bone. It is the same space that already has fluid moving around it.
We use landmarks — and often ultrasound — so the needle goes where it is meant to go and nowhere else.
Steroids are dangerous. They will weaken my bones and make me fat.
The dose here is tiny, and it is in one joint, not in your bloodstream.
This fear comes from steroid tablets taken every day for months or years — which genuinely do have those effects. A single injection into one joint is a different thing entirely.
What we do watch: your blood sugar may rise for a few days if you are diabetic, and we limit how many injections a joint gets in a year.
Once you start injections you become dependent on them.
There is nothing to become dependent on.
A steroid injection is not a painkiller you take daily and it causes no craving or withdrawal.
What is true is this: if a joint needs a third injection, that means the plan is not working — and we should be changing the plan, not repeating the injection. We will say so.
It only masks the pain. It does not treat anything.
That is half true, and it is worth understanding properly.
A steroid injection reduces inflammation. It does not repair cartilage or reverse arthritis, and we will never tell you it does.
Its real value is that it creates a window. When the pain drops, you can finally do the exercises that build the muscle — and that is what makes the difference last. An injection with no exercise programme behind it is a wasted opportunity.
An injection means surgery is next.
No. For many people it is what avoids surgery.
In a frozen shoulder, in trigger finger, in de Quervain's and in tendon sheath problems, an injection is often the definitive treatment.
It is not a last resort and it is not a step on a conveyor belt.
What actually happens
We examine the joint and mark the spot 1 minute
You sit or lie comfortably. We find the landmarks and mark the skin with a pen.
The skin is cleaned 30 seconds
Antiseptic solution. It feels cold. This is the part that prevents infection and we do not rush it.
Local anaesthetic A few seconds
A small sting, like a pinprick, then the area goes numb. For many joints the injection itself is mixed with local anaesthetic so there is only one needle.
The injection 20–30 seconds
You will feel pressure or a sense of fullness rather than sharp pain. Some people feel nothing at all. Tell us if it hurts — we can add more anaesthetic.
A small dressing, and you sit up 1 minute
A plaster. You can get up straight away. You do not need anyone to drive you.
Rest the joint for a day or two
No heavy work or long walking that day. Then gradually back to normal, and back to the exercises.
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