Joints in children can become inflamed and lead to a condition known as arthritis. These inflamed arthritic joints may sometimes need to be aspirated and/or injected with a medication as part of treatment. The medication used is a form of steroid called “Triamcinolone”. The purpose of the steroid injection is to help reduce the joint pain and swelling.

These steroid injections can be done in most joints and commonly done in the knees, ankles, wrists and elbows.

How are the steroid injections done?

Consent will firstly be obtained from you (parents) if your child is less than 18 years of age. Your paediatric rheumatologist will then mark the joint/s that need the injection.

If your child is young (e.g. less than the age of 10 years) or older but is very fearful of injections, these injections can be done with the child sedated or given general anaesthesia, meaning that your child will be given some medications to put he/she to sleep for a short while. These medications will be given by your doctor or an anaesthetist usually by an injection through your child’s vein, and the child will be unaware of the joint injection and feels no pain. For children older than 10 years, if your child is willing, this procedure can also be done using a local anaesthetic drug which is injected underneath the skin to numb the area.

After applying the sedation or local anaesthetic, your paediatric rheumatologist will then locate the ‘marked’ joint/s that need to be injected. A small needle (the same ones used to take blood samples) is then introduced into the joint space, and steroids will be injected through the same needle. Sometimes, excessive joint fluids may need to be aspirated for laboratory tests prior to the steroid injection.

The whole procedure (including preparation and sedation) might take between 30 minutes to up to 2 hours to complete depending on the number of joints that requires the steroid injections. However, the actual injection is very quick and often takes only minutes! This procedure is usually done as daycare case meaning that your child can go home once he/she has woken fully from the sedation.

Risks associated with injections into joints

This procedure is generally very safe and has minimal risk. 

Amongst the risks are:

1. Bruising or bleeding of the skin (puncture site) or joint
2. Infection in the joint (serious, but very rare)
3. ‘Crystal Synovitis’ – transient increase in joint pain for 24 hours (very rare)
4. Scars, or thinning of the skin, or loss of pigmentation of skin over the injection site
5. Calcium build-up over the injection site
6. Tendon rupture (serious, but very rare)

Food and Drinks before the procedure

If the procedure is done under sedation, your child must stop eating and drinking for at least 6 hours prior to the procedure time.

If your child has any health problems that prevent your child from fasting for more than 6 hours, please inform your doctor.

If your child needs to take any medications in the morning of the procedure, please ensure that it is taken at least 2 hours before the procedure with only clear water.

If your child is on medications like Aspirin, Warfarin and Enoxaparin, please inform your doctor as these medications can cause bleeding and need to be stopped prior to the procedure.  

If your child has a bleeding problem, please also inform your doctor prior to the procedure, so that the risk of bleeding can be assessed.

Day of steroid injection

Please arrive at a time advised by your doctor (generally at least 1 to 2 hours before the procedure time). Your child will be given hospital gown to wear and will have his/her weight, height and blood pressure measured by the nurse. You may also meet up with the anaesthetist (if required) who will ask you some questions about your child. Your paediatric rheumatologist will also examine your child again to check and confirm the joints which require to be injected.

After the procedure

If your child is given sedation, your child will be observed to allow your child to wake up. If your child complains of pain at the injection site, painkillers can be given to reduce the pain.

Once your child has woken up fully, is no longer dizzy or unsteady and is able to eat and drink without feeling nauseous/ vomit, your child can then be sent home. This usually happens 2 to 4 hours after the procedure.

Your child is advised to rest the injected joint/s for at least 24 hours to allow the steroid medication to work. If the leg joints have been injected, then your child is advised to avoid strenuous physical activities like running or sports for a day but is allowed to walk at home and do light duties.

Key points

• Joint and tendon injections help treat arthritis or inflammation of the joints.
• Children are given a general anesthetic or sedation for the procedure, if needed.
• Joint injections are usually considered a low-risk procedure.
• Your child needs to rest the injected area for 24 hours after the procedure.

Joint injection of the knee

In a joint injection, medication is injection into an area of the joint call the synovial space. The synovial space is filled with a liquid called synovial fluid
Source: http://www.aboutkidshealth.ca/En/HealthAZ/TestsAndTreatments/Procedures/Pages/Joint-and-tendon-steroid-injections-using-image-guidance.aspx