Infiltration Treatment for Joint Pain

Patient Selection Criteria

The American College of Physical Medicine and Rehabilitation recommends infiltration for patients with persistent joint pain for over a month with an intensity greater than 4/10, after failure of conservative treatments such as over-the-counter medications and physical therapy 1
Patients must have tried conservative therapies (over-the-counter medications, physical therapy) before considering infiltration 1
Infiltration can be considered for less intense or shorter-duration pain if it causes functional limitation despite conservative treatment 1
For sacro-iliac joints, the presence of 3 positive provocation tests out of 6 gives a sensitivity of 94% and specificity of 78% 1
For patients with predisposing factors such as pelvic trauma, spondyloarthritis, or previous L5-S1 fusion, 1-2 positive provocation tests may be sufficient 1

A strict aseptic technique is mandatory for all joint infiltrations 2
Imaging-guided techniques (ultrasound, fluoroscopy) can be used to improve injection accuracy 2
Local anesthetics can be combined with corticosteroids to reduce discomfort during the procedure 2

Corticosteroids are the treatment of choice for joint infiltrations 3
Local anesthetics can be combined with corticosteroids to reduce discomfort during the procedure 2

Intra-articular injection of long-acting corticosteroids is indicated for knee pain flares, especially if accompanied by effusion 3
Infiltration is particularly effective for sacro-iliac joint pain in patients with spondyloarthritis 1
Infiltration is not recommended for intra-articular techniques in total knee arthroplasty due to inconsistent analgesic efficacy 4

Infiltration should be avoided at least 3 months before joint replacement surgery 2
Diabetic patients, especially those with suboptimal control, should be informed of the risk of transient hyperglycemia after intra-articular glucocorticoid injection 2
The risk of bleeding is low, and most guidelines recommend maintaining anticoagulation 1

A single local injection is often sufficient, but multiple injections may be necessary for adequate symptom relief 1
Re-injection with corticosteroid may be appropriate if there is 75% or more relief after a diagnostic local anesthetic injection, or if there was at least 50% relief for at least 2 months after the first injection 1

The most frequently described side effects include pain, vagal reactions, vasomotor flushes, and/or sweating, and transient sciatic nerve block 1
The risk of septic arthritis after intra-articular infiltration is very low (0.035%) 2