Knowledge guides

LG15: Intra-articular steroid injection

Clinical sciences

Advanced Trainees will describe the principles of the foundational sciences.

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Eligibility considerations

Advanced Trainees will assess patients’ current conditions and plan the next steps.

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Less common or more complex presentations and conditions

Advanced Trainees will understand the resources that should be used to help manage patients with these presentations and conditions.

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Undertaking therapy

Advanced Trainees will monitor the progress of patients during the therapy.

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Post therapy

Advanced Trainees will know how to monitor and manage patients post-therapy.

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Important specific issues

Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management and integrate these into care.

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  • Anatomy of principal joints and surface markers of injection sites, such as:
    • lower limb joints, including:
      • ankles
      • knees
      • metatarsophalangeal
      • proximal and distal interphalangeal
      • subtalar
    • upper limb joints, including:
      • elbow
      • metacarpophalangeal
      • proximal and distal interphalangeal
      • shoulder
      • wrist
  • Principles of local steroid use, such as:
    • different steroid preparations
    • effectiveness
    • side effects
  • Appropriateness of repeated injections
  • Consideration of whether image-guided injection is indicated
  • Pre-procedure review of examination and imaging findings
  • Reasons for intra-articular administration of steroids as opposed to alternative routes, such as oral or intravenous administration, based on individual patients’ clinical scenarios
  • Anatomy of principal joints and surface markers of complex injection sites, such as:
    • axial joints, such as:
      • hip joints
      • sacroiliac
      • spinal
      • temporomandibular
    • bursae injections
    • mid-foot joints
    • tendon sheaths
  • Age-appropriate analgesia / sedation:
    • general anaesthesia
    • local anaesthesia
    • sedation, such as nitrous oxide
  • Aseptic technique
  • Aspiration of synovial fluid
  • Choice of steroid preparation and steroid dosage for different joints
  • Correct needle placement and use of imaging, such as x-ray or ultrasound, to confirm needle placement, as indicated
  • Identification of surface markers of injection sites
  • Patient and parental consent:
    • expected benefits of the procedure
    • risk of side effects, such as:
      • failure of procedure
      • infection
      • subcutaneous atrophy
  • Use of splinting / casting
  • Infection risk and appropriate patient / parental education / safety-netting
  • Return to exercise
  • Subcutaneous atrophy management
  • Multidisciplinary team involvement:
    • physiotherapy and occupational therapy for splinting / casting
    • radiology for image guided injections