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When corticosteroids and local anesthetics are used together, many patients will experience relatively rapid relief of symptoms following the injection. This is the initial action of the local anesthetic. Patients then often experience a transient increase in pain as the local anesthetic wears off. Longer-term symptom relief results as the injected corticosteroid takes effect. It is helpful to provide this anticipatory guidance to patients before the injection. Already a member or subscriber?

Log in. Interested in AAFP membership? Learn more. Stephens earned a master's degree in exercise physiology from The Pennsylvania State University, Hershey. Address correspondence to Mark B. Reprints are not available from the authors. The opinions and assertions contained herein are those of the authors and are not to be construed as official or as reflecting the views of the U. Navy Medical Department, the Navy at large, the U.

Air Force Medical Department, the U. Air Force at large, the U. Treatment of de Quervain's disease: role of conservative management. J Hand Surg [Br]. Corticosteroid injection for treatment of de Quervain's tenosynovitis: a pooled quantitative literature evaluation.

J Am Board Fam Pract. Comparison of nonsurgical treatment measures for de Quervain's disease of pregnancy and lactation.

J Hand Surg [Am]. Foley B, Christopher TA. Injection therapy of bursitis and tendinitis. Clinical Procedures in Emergency Medicine. Philadelphia, Pa. Saunders; — Evaluation of glucocorticosteroid injection for the treatment of trochanteric bursitis.

J Rheumatol. Prognosis of trochanteric pain in primary care. Br J Gen Pract. Visnes H, Bahr R. The evolution of eccentric training as treatment for patellar tendinopathy jumper's knee : a critical review of exercise programmes.

Br J Sports Med. Common overuse tendon problems: a review and recommendations for treatment. Am Fam Physician. Efficacy of injections of corticosteroids for subacromial impingement syndrome.

J Bone Joint Surg Am. A pragmatic randomised controlled trial of local corticosteroid injection and physiotherapy for the treatment of new episodes of unilateral shoulder pain in primary care.

Ann Rheum Dis. Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev. A combination of systematic review and clinicians' beliefs in interventions for subacromial pain. Local steroid injections for tennis elbow: does the pain get worse before it gets better? Results from a randomized controlled trial. Clin J Pain. Corticosteroid injections for lateral epicondylitis: a systematic overview.

Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial.

Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Arroll B, Goodyear-Smith F. Corticosteroid injections for osteoarthritis of the knee: meta-analysis. Intra-articular treatment of hip osteoarthritis: a randomized trial of hyaluronic acid, cortico-steroid, and isotonic saline. Osteoarthritis Cartilage. A randomised controlled trial of intra-articular corticosteroid injection of the carpometacarpal joint of the thumb in osteoarthritis.

Local corticosteroid injection for carpal tunnel syndrome. Surgical decompression versus local steroid injection in carpal tunnel syndrome: a one-year, prospective, randomized, open, controlled clinical trial. Arthritis Rheum. Combe B. Early rheumatoid arthritis: strategies for prevention and management. Best Pract Res Clin Rheumatol. Safety and efficacy of long-term intraarticular steroid injections in osteoarthritis of the knee: a randomized, double-blind, placebo-controlled trial.

Lack of effect of corticosteroid injection at the shoulder joint on blood glucose levels in diabetic patients. Clin Rheumatol. The effect of corticosteroid injection for trigger finger on blood glucose level in diabetic patients. Systemic effects of epidural and intra-articular glucocorticoid injections in diabetic and non-diabetic patients.

Joint Bone Spine. Diagnostic and therapeutic injection of the hip and knee. Denkler K. Helpful hints for injections of wrist and hand region. Diagnostic and therapeutic injection of the shoulder region. A randomized comparative study of short term response to blind injection versus sonographic-guided injection of local corticosteroids in patients with painful shoulder. Hall S, Buchbinder R.

Do imaging methods that guide needle placement improve outcome? A randomized controlled trial of the reciprocating procedure device for intraarticular injection of corticosteroid. Courtney P, Doherty M. Joint aspiration and injection. O'Connor FG. Common injections in sports medicine: general principles and specific techniques. In: O'Connor FG, ed. Sports Medicine: Just the Facts. Division; — Intra-articular corticosteroids. An updated assessment. Clin Orthop Relat Res.

Complications of plantar fascia rupture associated with corticosteroid injection. Foot Ankle Int. Caldwell JR.

Guide to selection and indications for use. Intra-articular injection. Med Clin North Am. The effect of corticosteroid on collagen expressionin injured rotator cuff tendon.

Preferred intraarticular corticosteroids and associated practice: a survey of members of the American College of Rheumatology. Arthritis Care Res. Hermosilla Molina A. Treatment of refractory traumatic arthritis of the fingers with intra-articular Ledercort [in Spanish]. Hisp Med. A comparison of plasma methylprednisolone concentrations following intra-articular injection in patients with rheumatoid arthritis and osteoarthritis.

Aust N Z J Med. National Library for Health. Osteoarthritis: management issues. Clinical knowledge summaries. Accessed December 14, Pfenninger JL. Injections of joints and soft tissue: part II. Guidelines for specific joints. Injection and aspiration techniques for the primary care physician. Compr Ther. Diagnostic and therapeutic injection of the ankle and foot. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.

This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv aafp. Want to use this article elsewhere? Get Permissions. Read the Issue. Sign Up Now. Next: Recurrent Miscarriage. Oct 15, Issue. Musculoskeletal Injections: A Review of the Evidence. Abstract Who to Inject? What about Diabetes? How to Inject?

What to Inject? Article Sections Abstract Who to Inject? B 1 , 2 Corticosteroid injection for trochanteric pain is safe and highly effective. C 4 , 5 Subacromial corticosteroid injection provides short-term pain relief that is greater than placebo and at least equal to nonsteroidal anti-inflammatory drug therapy.

B 9 , 11 , 12 Corticosteroid injection reduces short-term less than six weeks symptoms from lateral epicondylitis, but physical therapy is superior to steroid injection after six weeks. A 13 , 15 , 16 Intra-articular steroid injections reduce pain and swelling in osteoarthritis of the knee. This study showed triamcinolone hexacetonide with less pain and less disability at week 3, but methylprednisolone to be more effective at week 8 Two other studies were performed that showed no difference between methylprednisolone and triamcinolone 11 , Two studies have shown that triamcinolone hexacetonide offered longer lasting pain relief for patients with rheumatoid arthritis of the knee 13 , One systematic review in showed a trend that pain control was better with triamcinolone No difference was found in local site injection when comparing triamcinolone to betamethasone in one trial and hydrocortisone in another 9 , Overall, there is limited randomized control trials comparing the efficacy of depot corticosteroids for joint injections 1.

The choice of corticosteroids is typically based on training tradition and clinical experience but other factors are involved such as cost and availability. Cost and insurance reimbursement can vary by region. The paucity of evidence is the main reason there is so much variability in which agents are used for joint injections.

Douglas, R. Corticosteroid injection into the osteoarthritic knee: Drug selection, dose, and injection frequency. International Journal of Clinical Practice,66 7 , Caldwell JR. Intra-articular corticosteroids.

Guide to selection and indications for use. Intra-articular injection. Med Clin North Am. Cole, Brian and Harold R. Size and aggregation of corticosteroids used for epidural injections. Pain Med. In Chan L, et al, eds. Arthritis Care Res — J Bone Joint Surg Br ; Valtonen EJ. Clinical comparison of triamcinolone hexacetonide and betamethasone in the treatment of osteoarthrosis of the knee joint. Scan J Rheumatol Suppl ; 1—7.

Pyne, D. Intra-articular steroids in knee osteoarthritis: A comparative study of triamcinolone hexacetonide and methylprednisolone acetate. Clinical Rheumatology, 23 2 , Thorpe P: Intra-articular triamcinolone acetonide and methyprednisolone acetate in arthritis.