What to Expect from a Joint or Soft Tissue Injection

Why a joint injection?

When a specific joint or soft tissue area is inflamed — a swollen knee, a painful shoulder, a flared-up tendon — a local corticosteroid injection can deliver powerful anti-inflammatory medication exactly where it’s needed. Instead of treating your whole body with systemic medication, we target the problem at its source.

Joint and soft tissue injections are one of the most common procedures in rheumatology. They’re quick, well-tolerated, and often provide significant relief.

What’s being injected?

A typical injection contains two things:

• A corticosteroid (such as triamcinolone or methylprednisolone) — this is the anti-inflammatory medication that reduces swelling, pain, and stiffness in the joint or tissue
• A local anesthetic (lidocaine or marcaine) — this numbs the area and provides immediate but temporary pain relief while the steroid takes effect

The combination is drawn into a single syringe. The total volume is small — usually just 1 to 3 mL depending on the joint size and location.

The procedure

Here’s what happens, step by step:

• The skin is cleaned with an antiseptic — you’ll feel the cold wipe
• The area may be numbed with a topical spray or local anesthetic if needed
• Ultrasound guidance is used when indicated — Dr. Fellows is RhMSUS certified (Registered in Musculoskeletal Ultrasound) and uses our in-office Mindray MX7 to visualize the needle entering the joint in real time, ensuring precise placement
• The needle is inserted — you’ll feel pressure and possibly a brief sting, but most patients describe it as less painful than they expected
• The medication is injected — this takes just a few seconds
• The needle is removed and a small bandage is applied

The whole process — from prep to bandage — typically takes less than five minutes.

What to expect afterward

Relief doesn’t happen all at once. Here’s the typical timeline:

• Immediately: The local anesthetic kicks in, and you may notice reduced pain right away — this is the lidocaine or marcaine working, and it wears off within a few hours
• First 24–48 hours: The anesthetic fades and the steroid hasn’t fully taken effect yet — you may feel like you’re back to square one, or even slightly worse (see “post-injection flare” below)
• 24–72 hours: The corticosteroid begins to work, and you should notice the swelling and pain starting to improve
• Full effect: Most patients feel the maximum benefit within a week

The duration of relief varies — some patients get weeks of improvement, others get months. It depends on the underlying condition, the joint involved, and how active the inflammation is.

Post-injection flare

Some patients experience a post-injection flare — a brief worsening of pain and swelling in the first 24 to 48 hours after the injection. This is a reaction to the steroid crystals settling into the joint and is normal, not dangerous.

• Apply ice to the area for 15–20 minutes at a time
• Take acetaminophen (Tylenol) or an anti-inflammatory if you normally use one
• Rest the joint — the flare resolves on its own, usually within a day or two

If pain worsens significantly after 48 hours, or if the joint becomes hot, red, and swollen with fever — call our office immediately. These could be signs of infection, which is very rare but requires prompt attention.

Aftercare instructions

• Rest the injected joint for 24–48 hours — avoid heavy lifting, vigorous exercise, or repetitive strain on the area
• Ice is your friend if the site is sore — 15–20 minutes on, then off
• Light activity is fine — walking, gentle movement, daily tasks
• Keep the bandage on for a few hours; you can remove it the same day
• Showering is fine the same day — just avoid soaking the injection site (no baths, pools, or hot tubs) for 24 hours

For patients with diabetes

Corticosteroid injections — even local ones — can cause your blood sugar to rise for 1 to 3 days after the injection. This is expected and temporary, but it needs to be managed.

• Monitor your blood sugar more frequently for the first 2–3 days
• Contact your primary care doctor or endocrinologist if your readings are significantly above your usual range so they can help you adjust your diabetes medications temporarily
• Let us know before the injection if your diabetes is currently poorly controlled — we may need to coordinate with your other doctors or adjust our approach

Why we limit repeat injections

Corticosteroids are effective, but they’re not meant to be used indefinitely in the same joint. We typically limit injections to a given joint to no more than 3 to 4 times per year. Here’s why:

• Repeated steroid exposure can weaken cartilage and tendons over time, potentially accelerating joint damage rather than preventing it
• Diminishing returns — if a joint needs frequent injections, it usually means the underlying disease isn’t well-controlled and we need to adjust your systemic treatment
• Skin and tissue changes — repeated injections in the same area can cause thinning of the skin or loss of subcutaneous fat at the injection site

If you’re finding that injections are wearing off quickly or needed frequently, that’s an important conversation to have. It often means it’s time to escalate your treatment plan — not just keep injecting.

When to call us

• The injection site becomes increasingly painful, red, hot, or swollen after the first 48 hours
• You develop a fever after the injection
• You notice significant skin changes at the injection site — dimpling, color change, or persistent thinning
• Your symptoms don’t improve at all within a week

This handout is provided for educational purposes and does not replace individualized medical advice. Always follow the specific instructions given by your rheumatologist.