Joint injections

Joint injections are suggested when a joint is painful, swollen and is difficult to move. This can be caused by many conditions, but the most common is arthritis (inflammation of the joint). Injecting steroid medicine into the fluid around the joint can decrease pain and increase the range of movement. It can also treat disease within the joint itself.

The doctor will suggest joint injections based on your child’s current symptoms, the underlying cause of these symptoms and recent imaging studies. Joint injections on their own are unlikely to offer a ‘cure’ but can be helpful alongside other treatments such as physiotherapy, splinting and other longer-term medicines.

You will already have received information about how to prepare your child for the procedure in your admission letter. You may need to come to GOSH before the procedure so that your child can have a pre-admission assessment to check that they are well enough. This appointment may involve taking blood samples and other tests.

Your child will need to be admitted to a bed on a ward in the hospital. The person bringing your child to the procedure should have ‘parental responsibility’ for them. Parental responsibility refers to the individual who has legal rights, responsibilities, duties, power and authority to make decisions for a child. If the person bringing your child does not have parental responsibility, we may have to cancel the procedure.

A doctor will explain the procedure to you and ask you to sign a consent form for the procedure. There will be time to ask any questions and voice any concerns.

The doctor will also discuss whether your child needs a general anaesthetic for the procedure. Older children and young people may prefer to be awake and use a gas and air mixture called Entonox to help with anxiety and pain relief.

Many of the procedures we perform involve the use of X-rays. Legally, we are obliged to ask anyone over the age of 12 whether there is any chance they might be pregnant, and we will also ask for the first date of their last period (if started). This is to protect babies in the womb from receiving unnecessary radiation.

You will already have received information about how to prepare your child for the procedure in your admission letter. You may need to come to GOSH before the procedure so that your child can have a pre-admission assessment to check that they are well enough. This appointment may involve taking blood samples and other tests.

This test can be performed under local, Entonox® or general anaesthetic. Your admission letter will specify which type you need to prepare for. For local anaesthetic there is no fasting required. For Entonox® fasting is required for 1 hour before the procedure – this means no food or water. For general anaesthetic please follow the below instructions.

Your child needs to be fasted for the procedure for the general anaesthetic. If your child takes regular medication, please speak to your child’s team about when to stop these before the procedure.

As a general rule:

Food and milk:

• Breast-fed babies- can have their last feed three hours before the procedure. Breast milk is digested faster than solid food or formula.
• Bottle-fed babies and children- can have their last milk feed, food or milk drink, six hours before the procedure. They should not have any food or milk after this time.

Water:

• All babies and children can have a drink of water (but no other fluids), until one hour before the procedure.

It is equally important to keep giving your child food and drink until those times to ensure they remain well-hydrated and get adequate nutrition. This may involve waking your child in the night to give them a drink which we recommend.

Please follow these instructions carefully, otherwise your child’s procedure may be delayed or even cancelled.

The procedure is carried out in Interventional Radiology (IR).

Once your child is under general anaesthetic or sedated with Entonox®, the doctor will clean the area over the joint and insert a small needle into the fluid filled area around the joint bones. They will inject a small amount of contrast, a liquid that shows up well on X-rays, to confirm that the needle is in the correct position. When it is in the correct position, they will inject a mixture of steroid medicine and local anaesthetic. They will remove the needle and cover the injection site with a small plaster.

If your child will be having the procedure under general anaesthetic, every anaesthetic carries a risk, but this is extremely small.

The risk of infection with this procedure is extremely small as no incisions are made in the skin. Occasionally it is difficult to inject much medicine into the joint space, especially if the joint is extremely swollen. If this is the case, other medicines may be prescribed to reduce the swelling before the injections are tried again. Some joints in the body respond better to steroid medicine injections than others so additional or alternative treatments might be needed.

The procedure does involve the use of X-rays. The levels that are used are low dose and therefore low risk. If you have any concerns regarding the use of radiation, please discuss this with the person performing your procedure beforehand.

Physiotherapy and medicines taken by mouth or intravenously (via the veins) can be used as an alternative to joint injections. The doctor will explain all the options suitable for your child before you make a decision.

Your child will return to the ward after they have recovered from the general anaesthetic (if they have had it). Some children feel sick and vomit after a general anaesthetic. Your child may have a headache or sore throat or feel dizzy, but these side effects are usually short-lived and not severe.

Your child can start eating and drinking as normal once they feel like it.

If your child does not need to stay in hospital for other treatment, you can return home once they have recovered from the anaesthetic or sedation. They should rest for the first 24 hours but then continue with the physiotherapy and exercises as advised.

You should call the hospital (or go to A&E out of hours) if:

• Your child is in a lot of pain and pain relief does not seem to help.
• The injection site looks red, swollen and feels hotter than the surrounding skin.
• The incision site is oozing.
• Your child has a temperature of 38⁰C or higher.

You can call the ward by calling the GOSH switchboard and asking for the ward your child was discharged from.

Telephone: 020 7405 9200

If you are unable to get through, please call NHS111 by dialling 111.

Contact information

If you have any questions, please speak to you child’s doctor or nurse or call Interventional Radiology.

Telephone: 020 7405 9200 extension 7943.

You can also contact us through MyGOSH.