Joint injections

Some children with rheumatologic problems such as JIA require injections of steroid into the joint. It’s usually effective because it does three things at once: treats the inflammation, decreases the damage to the joint and provides pain relief.

The medical term for a joint injection is intra-articular injection. The procedure involves inserting a needle into the space between the bones in a joint to inject a long-acting steroid called Triamcinolone hexacetonide. Sometime excess fluid will be removed from the inflamed joint.

Your doctor will explain the risks of the joint injection before the procedure and ask you to sign a consent form as per other treatments. The side effects are explained in this information sheet and include a very remote risk of joint infection and possible later skin atrophy. Don’t hesitate to ask all your questions, it’s important you understand the treatment and feel comfortable with the procedure.

The injections can cause stinging to the joint and some children find this painful and uncomfortable. The younger a child is, the harder it is for them to manage without some sort of pain relief.

Depending on which joint or how many need to be injected, children receive the treatment in three ways.

For very young children, giving the injection under general anaesthetic (GA) allows us to safely inject the medicine into the joint without the worry that the child may move. This is often in the best interest of the child as they are too young to understand and follow the necessary instructions.

For the very small joints (such as those in the hands or feet) or deep joint (hips), children can have the injection by guided ultrasound. The GA allows this to be done safely and with minimal worry for the child.

If several joints require treatment, it’s our experience that the treatment is easier for the child for this to be done under a GA. It minimises worry and distress for the child.
- Read Preparing your child for medical procedures
- Read the Anaesthesia and day surgery factsheet
- Read the Anaesthesia and risk in infants factsheet
- Sydney Children’s Hospital, Randwick and The Children’s Hospital at Westmead provide information about staying in hospital.

For preschool or older children who need several joints treated, nitrous oxide is very effective tool and avoids the need for GA.

Nitrous oxide is often called laughing gas. It gives a light anaesthetic to reduce pain during the procedure. The nitrous oxide is mixed with oxygen and administered through a mask over the child’s mouth and nose.

Some children will receive an additional medicine called Midazolam, which makes the child feel a bit sleepy and relaxed. It also makes them forget the procedure.

Children receive procedure preparation and support through the Hospital’s Child Life specialists who are skilled at explaining complex procedures to children and help them relax before the procedure.
- Read the Nitrous Oxide factsheet
- Read about Child Life Therapy

Many parents ask how long takes before they see a response to the steroid injection. Many patients report that within a few days they are able to move the joint more freely and experience less pain.

The day following the procedure, we suggest that children not participate in strenuous exercise such as sport or dance training, but they are welcome to continue normal daily activities, attend school, and ‘play’ as if they feel up to it.

After 48 hours, if your child wants to return sport and feels comfortable, they are welcome to.

Anne Senner, PRN Clinical Nurse Consultant.