Therapeutic Joint Injections

Joint injections are a form of treatment for children with arthritis. We inject a high-dose steroid directly into the joint, most commonly the temporomandibular joint (TMJ) in the jaw or the subtalar joint in the foot. This procedure occurs in Interventional Radiology because these joints are difficult to locate, and the healthcare provider must use ultrasound, live X-ray (fluoroscopy) or CT scan for guidance.

How is a joint injection performed?

Using ultrasound, live X-ray or CT scan for guidance, your provider will place a small needle into the affected joint. In some cases, a small amount of X-ray dye (contrast)is injected to confirm that the needle is within the joint. Once placement is confirmed, liquid steroid medicine is injected. Then we will remove the needle and apply a bandage.

How long does the procedure take?

Less than one hour.

Will my child be awake for the procedure?

No. We will use either IV sedation or general anesthesia so that your child is not awake.

What are the risks of joint injections?

This is considered a low-risk procedure. However, potential complications include:

• Bleeding

• Infection

• Allergic reaction to X-ray dye (contrast reaction)

• Dimpling or paleness at the injection site

• Nerve injury

• Injury to the eardrum (with TMJ only)

Will my child feel any pain after the injection?

Most patients do not experience pain or discomfort after the procedure. Some feel fullness in the joint for a few days until the liquid medicine is absorbed. The injection site may be tender to the touch. You may give your child over-the-counter pain medication. The injection site may swell within the first 24 hours. The swelling should go down within three to five days.

When can I remove the bandage?

The bandage must stay dry and in place for 24 hours. After 24 hours you may remove the clear bandage and gauze, or the adhesive bandage.

When can my child bathe?

Your child can shower or take a bath after the bandage is removed.

Are there any activity restrictions?

We suggest your child limit activity for 24 hours. Your child can go to day care or school but should not participate in sports or strenuous activity. This is especially true if the injection was in the foot.

If the temporomandibular joint (TMJ) was injected, your child should avoid hard, chewy foods for several days.

Contact your CHOP healthcare team immediately if your child has:

• Fever higher than 101° F (38.3° C)

• Redness at the injection site

• Pain that isn’t helped by over-the-counter medication

• Swollen injection site after three to five days

Interventional Radiology

8 a.m. and 4:30 p.m., Monday through Friday, 215-590-7000. Follow the prompts.

At all other times, call 215-590-1000, ask for the interventional radiologist on call.

Reviewed February 2024 by Kirsten Spichiger, DNP, CRNP