Understanding Joint Injections: A Patient's Complete Guide

Key Takeaways

• Joint injections deliver medication directly to the source of pain, often providing relief when oral medications fail
• Corticosteroid (cortisone) injections provide rapid but temporary relief from inflammation
• Hyaluronic acid injections restore joint lubrication and may provide longer-lasting relief
• PRP and stem cell injections are emerging treatments with mixed research evidence
• Most injections are office procedures taking 10-30 minutes with minimal recovery time
• Understanding the differences helps you have informed discussions with your doctor

If you’ve tried physical therapy, changed your lifestyle, and taken oral medications but still struggle with joint pain, your doctor may recommend joint injections. This comprehensive guide explains the different types of injections available, what to expect during and after the procedure, and how to determine which option might be right for you.

Why Inject Medication Directly Into Joints?

Oral medications must travel through your entire body before reaching your painful joint. Much of the medication is filtered by your liver and kidneys, meaning only a small percentage actually reaches the target area. This systemic approach also increases the risk of side effects in other parts of your body.

Joint injections, also called intra-articular injections, deliver medication directly where it’s needed:

• Higher concentration at the site of pain and inflammation
• Faster relief in many cases
• Fewer systemic side effects compared to oral medications
• Longer-lasting relief for some injection types
• Better option when oral medications cause stomach problems or other side effects

The Four Main Types of Joint Injections

1. Corticosteroid Injections (Cortisone Shots)

Corticosteroid injections are the most common type of joint injection and have been used for over 50 years.

What They Are

Corticosteroids (commonly called “cortisone” though that’s technically just one type) are powerful anti-inflammatory medications similar to hormones your body produces naturally. When injected into a joint, they rapidly reduce inflammation, swelling, and pain.

Common corticosteroids used include:

• Triamcinolone (Kenalog)
• Methylprednisolone (Depo-Medrol)
• Betamethasone (Celestone)

How They Work

Corticosteroids suppress your immune system’s inflammatory response in the joint. Think of inflammation as a fire—cortisone doesn’t fix what caused the fire, but it puts out the flames quickly and effectively.

They work by:

• Reducing production of inflammatory chemicals
• Decreasing blood vessel dilation
• Reducing swelling and pressure
• Interrupting the pain cycle

What to Expect

Before the injection:

• No special preparation needed in most cases
• Some doctors recommend stopping blood thinners temporarily (always follow your doctor’s advice)
• The procedure takes 10-15 minutes in an office setting

During the injection:

• Your doctor cleans the injection site thoroughly
• A local anesthetic may be used to numb the skin
• You’ll feel pressure and brief discomfort as the needle enters the joint
• The medication includes both the corticosteroid and usually a local anesthetic for immediate relief

After the injection:

• You can go home immediately
• Avoid strenuous activity for 24-48 hours
• Some people experience a “cortisone flare”—temporary increased pain for 24-48 hours as the medication settles
• Relief typically begins within 24-72 hours
• Maximum benefit reached in 3-7 days

How Long Relief Lasts

• Typically 6 weeks to 6 months
• Duration varies significantly between individuals
• First injection often provides longest relief
• Subsequent injections may be less effective or shorter-lasting

Limitations and Risks

Corticosteroid injections are safe when used appropriately, but there are important considerations:

Frequency limits: Most doctors recommend no more than 3-4 injections per year in the same joint. Repeated cortisone exposure may accelerate cartilage breakdown.

Potential side effects:

• Temporary increase in blood sugar (concern for diabetics)
• Facial flushing
• Insomnia for a few nights
• Temporary increase in blood pressure
• Thinning of skin at injection site (with repeated injections)
• Risk of infection (rare, less than 1 in 10,000)

Read our detailed article: Cortisone Injection Risks: Overuse and Cartilage Damage

Best For

• Sudden arthritis flare-ups
• Inflammatory conditions (rheumatoid arthritis, gout, bursitis)
• Short-term pain relief while pursuing other treatments
• Situations where quick relief is important

Not Ideal For

• Long-term arthritis management (due to frequency limits)
• Infections in or near the joint
• People with uncontrolled diabetes
• Patients needing repeated injections throughout the year

2. Hyaluronic Acid Injections (Viscosupplementation)

Hyaluronic acid (HA) injections represent a different approach—they don’t reduce inflammation but instead restore your joint’s natural cushioning and lubrication.

What They Are

Hyaluronic acid is a natural substance found in healthy synovial fluid—the slippery liquid that lubricates your joints. In osteoarthritis, this fluid becomes thin and less effective. HA injections supplement or replace the diminished fluid.

FDA-approved brands for knee osteoarthritis:

• Single-injection products: Synvisc-One, Monovisc, Gel-One, Durolane
• 3-injection series: Synvisc, Supartz, Hyalgan
• 5-injection series: Euflexxa, Orthovisc

While FDA-approved specifically for knees, some doctors use HA injections “off-label” for other joints like shoulders and hips.

How They Work

HA injections work through multiple mechanisms:

• Lubrication: Restore the slippery quality of joint fluid, reducing friction
• Shock absorption: Cushion impacts during movement
• Anti-inflammatory effects: Reduce inflammatory chemicals in the joint
• Cartilage protection: May help slow cartilage breakdown

Think of it as adding fresh oil to a rusty hinge rather than just numbing the squeak.

What to Expect

Before the injection:

• Your doctor may drain excess fluid from your knee if severely swollen
• No special preparation needed for most patients
• Some doctors perform injections with imaging guidance (fluoroscopy or ultrasound) for improved accuracy

During the injection:

• Similar process to cortisone injections
• Takes 10-15 minutes
• Brief discomfort as needle enters joint
• May feel fullness or pressure as medication fills the joint space

After the injection:

• Rest for remainder of the day
• Avoid strenuous activity for 48 hours
• Can take over-the-counter pain relievers if needed
• About 10-20% experience temporary increased pain or swelling for 24-48 hours
• Apply ice if the joint feels warm or swollen

How Long Relief Lasts

Relief develops more gradually than cortisone:

• Improvement usually begins 2-4 weeks after injection(s)
• Maximum benefit at 8-12 weeks
• Relief typically lasts 3-6 months
• Some patients report relief lasting up to 12 months
• Can be repeated indefinitely if effective

Limitations and Risks

Potential side effects:

• Temporary pain, swelling, or warmth at injection site
• Rare allergic reactions (especially in people with bird/egg allergies for some brands)
• Infection risk (very rare)
• Pseudo-septic reaction—temporary joint inflammation that mimics infection

Insurance considerations:

• Medicare covers HA injections for knee OA
• Some Medicare Advantage plans are eliminating coverage (check your specific plan)
• Most commercial insurance covers with prior authorization
• Cost without insurance: $500-$1,500 depending on brand

Read more: HA Brands Guide 2025

Best For

• Moderate to severe knee osteoarthritis
• Patients who can’t tolerate NSAIDs or other oral medications
• Those needing repeated injections throughout the year
• Patients wanting to delay or avoid surgery
• People who respond poorly to cortisone or have maxed out cortisone frequency

Not Ideal For

• Severely damaged joints (bone-on-bone)
• Active joint infections
• Those with severe bird/egg allergies (some brands)
• Patients needing immediate relief (effect is gradual)

3. PRP (Platelet-Rich Plasma) Injections

PRP represents a newer approach using your own blood to potentially promote healing.

What They Are

PRP injections use concentrated platelets from your own blood. Platelets contain growth factors that may stimulate tissue repair and reduce inflammation.

The PRP Process:

1. Blood is drawn from your arm (like a normal blood test)
2. Your blood is placed in a centrifuge to separate components
3. The platelet-rich portion is extracted and concentrated
4. This concentrated PRP is injected into your joint

How They (Theoretically) Work

Proponents believe PRP:

• Releases growth factors that promote cartilage healing
• Reduces inflammation through anti-inflammatory proteins
• Stimulates the body’s natural repair mechanisms
• May slow arthritis progression

The Evidence

Research on PRP is mixed and evolving:

• Some studies show significant pain reduction and function improvement
• Other studies show no benefit beyond placebo
• Results vary based on PRP preparation methods, concentration, and patient factors
• More high-quality research is needed

Read our comprehensive review: PRP Injections Evidence Review

What to Expect

The procedure:

• Blood draw followed by processing (30-45 minutes total)
• The injection process is similar to other joint injections
• Usually done in a series of 2-3 injections spaced 2-4 weeks apart

After the injection:

• Rest for 24-48 hours
• Often more post-injection discomfort than other injection types
• May take 6-12 weeks to see maximum benefit
• Duration of relief varies widely

Limitations and Risks

Major limitation: Insurance typically doesn’t cover PRP

• Cost: $500-$2,000 per injection
• Usually requires a series of 2-3 injections
• Total cost can be $1,500-$6,000

Evidence limitations:

• Not FDA-approved specifically for arthritis
• Inconsistent research results
• No standardized preparation or injection protocol

Potential risks:

• Infection (uses your own blood, so lower risk than other injections)
• Pain and swelling at injection site
• No guarantee of benefit

Best For

• Patients who’ve failed standard treatments
• Younger patients with mild to moderate arthritis
• Those willing to pay out-of-pocket for potential benefit
• Patients interested in “regenerative” approaches

Not Ideal For

• Those on a limited budget
• Patients needing proven, evidence-based treatments
• Those requiring insurance coverage
• People expecting guaranteed results

4. Stem Cell Injections

Stem cell therapy is perhaps the most controversial and least understood option.

What They Are

Stem cells are cells capable of developing into different cell types. The theory is that injecting stem cells into damaged joints might regenerate cartilage or reduce inflammation.

Types of stem cell sources:

• Bone marrow aspirate
• Adipose (fat) tissue
• Umbilical cord blood

The Reality

Important facts:

• Not FDA-approved for osteoarthritis treatment
• Very limited high-quality research supporting effectiveness
• Extremely expensive ($3,000-$10,000+)
• No insurance coverage
• Highly variable quality and techniques between providers
• Many clinics making unsubstantiated claims

What Research Shows

Most stem cell research for arthritis is:

• Small studies without control groups
• Short-term follow-up
• Inconsistent methods making comparisons difficult
• Minimal evidence of actual cartilage regeneration in humans

Major Concerns

The stem cell field includes many unregulated clinics making misleading claims:

• Promising “cartilage regeneration” without evidence
• Guaranteeing results
• Downplaying risks
• Charging enormous fees for unproven treatments

Our Recommendation

Until more rigorous research demonstrates clear benefit, stem cell injections should be viewed as experimental. If considering this option:

• Research the provider thoroughly
• Ask about their specific outcomes data
• Understand you’re essentially participating in an experiment
• Don’t sacrifice proven treatments for unproven ones
• Be very skeptical of guaranteed outcomes

Comparing Injection Types: Side by Side

Feature	Corticosteroid	Hyaluronic Acid	PRP	Stem Cell
Onset of Relief	1-3 days	2-4 weeks	4-12 weeks	Unknown
Duration	6 weeks-6 months	3-6 months	Varies widely	Unknown
Frequency Limits	3-4 per year	Unlimited	No formal limits	No formal limits
Medicare Coverage	Yes	Yes (for knees)	No	No
Commercial Insurance	Yes	Usually	Rarely	No
Cost (out-of-pocket)	$100-300	$500-1,500	$500-2,000	$3,000-10,000+
FDA Approved	Yes	Yes (for knees)	No	No
Evidence Level	Strong	Moderate	Limited	Insufficient
Number of Injections	Usually 1	1-5 (varies by brand)	Usually 2-3	Usually 1-3
Best For	Flare-ups	Long-term management	Experimental option	Research settings only

Imaging-Guided vs. Landmark-Based Injections

Joint injections can be performed two ways:

Landmark-Based (Blind) Injections

The doctor uses anatomical landmarks to guide needle placement based on feel and experience.

Advantages:

• Faster procedure
• Done in office without special equipment
• Lower cost

Disadvantages:

• Lower accuracy, especially for deeper joints
• Higher chance of medication placement outside the joint
• More discomfort for patient

Imaging-Guided Injections

The doctor uses real-time imaging to visualize the needle entering the joint.

Types of imaging:

• Fluoroscopy (X-ray guidance): Most common for deeper joints
• Ultrasound: Growing in popularity, no radiation

Advantages:

• Confirms medication delivered precisely into joint
• Especially important for difficult-to-access joints (hip, shoulder)
• May improve outcomes
• Can see and drain fluid before injecting medication
• More comfortable for patient

Disadvantages:

• Takes slightly longer
• May cost more
• Requires special equipment
• Not necessary for easy-to-access joints like knees

Evidence on Accuracy

Studies show:

• Landmark-based knee injections are accurate 70-95% of the time
• Hip and shoulder injections are accurate only 30-70% without imaging
• Imaging guidance improves accuracy to 95%+

For knee injections, imaging may not be necessary in experienced hands. For hips and shoulders, imaging guidance is strongly recommended.

What to Expect: The Injection Procedure

While specific details vary by injection type and joint, here’s the general process:

Before Your Appointment

Prepare your questions:

• Which injection type is being used and why?
• How many injections will I need?
• When should I expect relief?
• What activities should I avoid afterward?
• What are the warning signs of complications?

Medication considerations:

• Ask if you should stop blood thinners (aspirin, warfarin, etc.)
• Take any regular medications as prescribed unless instructed otherwise
• Bring a list of all medications and allergies

Day of procedure:

• Wear comfortable, loose clothing
• Bring a driver if receiving sedation (rare for joint injections)
• Eat normally unless instructed otherwise

During the Procedure

1. Positioning: You’ll be positioned for best access to the joint
2. Sterilization: The injection site is thoroughly cleaned with antiseptic
3. Numbing (optional): Local anesthetic may be applied to the skin
4. Needle insertion: You’ll feel pressure and brief sharp pain
5. Fluid aspiration (if needed): Excess fluid may be removed first
6. Medication injection: Takes just a few seconds
7. Bandaging: A small bandage covers the injection site

Most patients describe the discomfort as:

• Brief sting as the needle enters
• Pressure sensation as medication fills the joint
• Tolerable without sedation
• Less painful than anticipated

Immediately After

• Rest for 10-15 minutes before leaving
• Apply ice if directed
• You can drive yourself home (unless you received sedation)
• Return to light activities same day
• Avoid strenuous activity for 24-48 hours

The First 48 Hours

Normal responses:

• Mild soreness at injection site
• Feeling of fullness in the joint
• Some people feel worse before feeling better (especially with cortisone and PRP)

When to call your doctor:

• Fever over 100.4°F
• Severe, worsening pain
• Significant swelling
• Warmth and redness that worsens after 48 hours
• Inability to bear weight

Infections are rare (less than 1 in 10,000 injections) but require immediate treatment.

Maximizing Benefit from Joint Injections

Injections work best as part of a comprehensive treatment plan, not as standalone solutions.

Before Your Injection

• Continue physical therapy and exercises
• Maintain a healthy weight
• Stay active with low-impact exercise
• Optimize other treatments

After Your Injection

For cortisone:

• Expect rapid improvement within days
• Use the pain relief window to engage in physical therapy
• Don’t overdo it just because pain is reduced
• Plan activities carefully to make the most of pain-free time

For hyaluronic acid:

• Be patient—relief takes 2-4 weeks
• Continue gentle exercise
• Track your symptoms to determine if it’s helping
• Give it a full 12 weeks before deciding if it worked

For PRP:

• Follow activity restrictions closely
• Avoid NSAIDs which may interfere with healing
• Continue physical therapy
• Plan for a longer evaluation period (3-6 months)

Long-Term Strategies

• Continue weight management
• Maintain exercise program
• Use injections to keep you active enough to do physical therapy
• Consider injections as part of delaying surgery, not avoiding it forever
• Track which injection types work best for you

Questions to Ask Your Doctor

About the Injection Type

• Why are you recommending this injection type for me?
• What are the alternatives?
• What’s your success rate with this injection?
• How many of these have you performed?

About the Procedure

• Will you use imaging guidance?
• What brand/type of medication will you use?
• How many injections will I need?
• Can I drive myself home?

About Results

• When should I expect improvement?
• How long will relief last?
• What’s my chance of significant benefit?
• What if it doesn’t work?

About Safety

• What are the risks specific to my health conditions?
• What medications should I stop before the injection?
• What are the warning signs of complications?
• When should I call if I have concerns?

About Insurance

• Does my insurance cover this injection?
• Do I need prior authorization?
• What will my out-of-pocket cost be?
• Are there less expensive alternatives?

Making Your Decision: Which Injection Is Right for You?

No single injection type is “best” for everyone. The right choice depends on multiple factors:

Consider Cortisone If You:

• Need rapid relief from a flare-up
• Have inflammatory arthritis
• Are trying to avoid surgery in the near term
• Want a low-cost, covered option
• Can’t take NSAIDs or other oral medications

Consider Hyaluronic Acid If You:

• Have moderate knee osteoarthritis
• Need repeated injections throughout the year
• Want longer-lasting relief
• Have maxed out cortisone frequency
• Prefer treatments that work with your body’s natural systems

Consider PRP If You:

• Have failed standard treatments
• Are willing to pay out-of-pocket
• Want to try regenerative approaches
• Understand the limited evidence
• Have realistic expectations

Avoid Stem Cell Injections Unless:

• You’re participating in a legitimate clinical trial
• You’ve exhausted all proven treatments
• You fully understand it’s experimental
• You can afford to lose the money if it doesn’t work
• The provider has published outcomes data

Frequently Asked Questions

How painful are joint injections?

Most people describe brief discomfort—a sharp sting as the needle enters, then pressure as medication fills the joint. The entire discomfort lasts 10-15 seconds. Many patients say it’s less painful than dental work or blood draws. The anticipation is often worse than the actual injection.

Can I get different types of injections at the same time?

Generally, no. Doctors typically don’t mix injection types in the same visit. However, you might get cortisone in one visit, then switch to hyaluronic acid in future visits if cortisone works well but you need more frequent relief than is safe with repeated cortisone.

How many injections can I safely have?

This depends on the injection type:

• Cortisone: Limit to 3-4 per year in the same joint
• Hyaluronic acid: Can be repeated every 6 months indefinitely if effective
• PRP: No formal limits but expensive and limited evidence
• Stem cell: Not recommended routinely

Will my injection be covered by insurance?

Coverage varies:

• Medicare: Covers cortisone and hyaluronic acid for knees
• Commercial insurance: Usually covers cortisone and HA with prior authorization
• PRP and stem cells: Rarely covered by any insurance

Always verify coverage with your insurance before the procedure.

What if the injection doesn’t work?

If one injection type doesn’t help:

• Wait the full expected time for benefit before giving up (12 weeks for HA)
• Try a different injection type
• Consider that inaccurate placement might have been the problem (try imaging-guided next time)
• Explore non-injection treatments
• Discuss whether surgery might be appropriate

Can injections damage my joint?

• Cortisone: Repeated, frequent injections may accelerate cartilage damage—this is why there are frequency limits
• Hyaluronic acid: No evidence of joint damage; considered very safe for repeated use
• PRP: Limited long-term data but no major concerns so far
• All injections: Carry small infection risk (less than 1 in 10,000)

How long do I need to rest after an injection?

• Rest for the remainder of the day
• Avoid strenuous activity for 24-48 hours
• Return to gentle activities within a few days
• Resume full activities gradually as comfort allows
• Use the pain relief to engage in physical therapy, not to overdo activities

Are there alternatives to injections?

Yes, many alternatives exist:

• Oral medications (NSAIDs, acetaminophen, prescription options)
• Physical therapy and exercise
• Weight management
• Assistive devices (braces, canes)
• Radiofrequency ablation
• Surgery (when conservative options fail)

Injections are just one tool in the treatment toolbox.

The Bottom Line

Joint injections can provide significant relief when oral medications and lifestyle changes aren’t enough. The key is understanding your options, having realistic expectations, and working closely with your doctor to find the right approach for your situation.

Remember:

• Injections work best as part of a comprehensive treatment plan
• No injection type works for everyone
• Relief is temporary—injections manage symptoms but don’t cure arthritis
• Stay active and engaged in physical therapy even when pain improves
• Keep surgery as a last resort, but don’t delay it indefinitely if quality of life is poor

With the right approach, joint injections can help you stay active, reduce pain, and maintain quality of life for months or years.

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Related Resources:

• HA Brands Guide 2025: Comparing Viscosupplementation Options
• Cortisone Injection Risks: Overuse and Cartilage Damage
• PRP Injections Evidence Review
• Medicare Coverage for Joint Injections FAQ
• Joint Injection Side Effects: What to Watch For

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This guide is for educational purposes only and should not replace advice from your healthcare provider. Always consult with your doctor before starting any new treatment.

Last medically reviewed: January 2025