Corticosteroids are commonly used for joint injections. When obtaining informed consent for such a procedure, what are the potential side effects that must be discussed with a patient? What are the absolute and relative contraindications to such an injection?
- Infection
(This is quite rare, with an estimated risk of 1/10,000) - Tendon rupture
- Post-injection flare
(an acute arthritis that is likely due to crystallization of the steroid within the joint) - Skin atrophy/depigmentation at site of injection
(a particular risk in dark-skinned individuals) - Facial flushing which may last one or two days
- Temporary worsening of glycemic control in diabetics (lasting days)
Contraindications to corticosteroid injection include:
- Infected tissue overlying the injection site
- Suspected infection in the joint to be injected
- Bacteremia
- Prosthetic joints – you should involve orthopedics rather than placing a needle in a prosthetic joint for any reason, as the risk of introducing an infection is much higher than in a native joint.
- Patients who are anticoagulated can be aspirated or injected with caution if they are within a therapeutic INR or PTT range.
