Anesthetic and Corticosteroid Joint Injections: A Primer

Complex joint anatomy may render the clinical diagnosis of a patient with joint pain difficult. Pain may be referred to a joint from an adjacent area (e.g., from the back to the hip) making the diagnosis difficult. The radiologist with the use of fluoroscopy is the ideal person to perform diagnostic and therapeutic joint injections. Long-acting anesthetic alone or combined with a corticosteroid may help the clinician localize the cause of the joint pain and subsequently institute the proper therapy. This article includes a discussion of the commonly used injectable corticosteroids that are available. The choice of corticosteroid is based on personal preference. Depomedrol (Upjohn, Kalamazoo, MI) is the least expensive corticosteroid available; however, a relatively insoluble drug such as Aristospan (Lederle, Deerfield, IL) or a combination drug such as Celestone Soluspan (Schering, Kenilworth, NJ) may be a better choice in rheumatoid arthritis. The technique used to inject the hip and the shoulder is discussed.