How is corticosteroid injection performed for joints and soft tissue injuries?

Updated: Mar 01, 2019
  • Author: Jess D Salinas, Jr, MD; Chief Editor: Elizabeth A Moberg-Wolff, MD  more...
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Answer

Answer

For muscle trigger point injections, the needle is inserted directly into the trigger point. The plunger should always be withdrawn to confirm that a blood vessel has not been penetrated before injecting the cortisone. The needle may remain in place but can be moved up and down and turned without withdrawing it from the skin. The needle should be angled into 3-4 areas of the trigger point.

It should be remembered that some of the benefit of the injection is the mechanical disruption of scar tissue. For periarticular injections, the injection should not be made directly into the tendon, lest the patient develop mechanical disruption or weakening of the tendon. Injection of the cortisone is accomplished in small droplets around the area of inflammation. Multiple injections may be required to infiltrate several centimeters of the tendon and muscle. Joint injections are accomplished by inserting the needle directly into the joint. Identification of joint injection sites is beyond the scope of this article, but information can easily be found in several guides to injection. This author's personal favorite reference for muscle trigger points is Myofascial Pain and Dysfunction:The Trigger Point Manual, by J Travell and D Simons. [28]

Following the injection procedure, it is often helpful to ice the area. The injection itself is traumatic and results in swelling and edema, the very problems requiring treatment. Immediate icing of the area reduces this inflammatory response. The patient should be told what to expect. For the first 2 hours, the patient may feel quite comfortable because the area is numb from the local anesthetic. However, this lack of discomfort lasts only 2 hours and is replaced by increased pain that is often worse than the pain experienced before the injection.

The patient should be reminded that a needle has been stuck into a sore spot. This increased tenderness often lasts 2 days and should be treated at home with ice. By warning the patient up front of the level of pain to expect, the clinician can avoid many emergency calls. Obviously, the patient should also be cautioned that any unexpected symptoms (eg, excessive bleeding, allergic reactions, chest tightness, wheezing) should be evaluated immediately in an emergency department.


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