Where should steroid shots be administered?

Administration Sites for Steroid Injections: A Clinical Guide

Steroid injections should be administered at specific anatomical sites depending on the condition being treated, with intra-articular injections requiring strict aseptic technique and appropriate imaging guidance for certain joints.

Intra-articular Injections

Intra-articular corticosteroid injections are commonly used for joint conditions and should be administered as follows:

Dosing by Joint Size

• Large joints (knee, ankle, shoulder): 20-40 mg triamcinolone or 20-80 mg methylprednisolone 1
• Medium joints (elbow, wrist): 10-40 mg triamcinolone or 10-40 mg methylprednisolone 1
• Small joints (fingers, toes): 4-10 mg triamcinolone or 4-10 mg methylprednisolone 1

Imaging Guidance Requirements

• Hip injections: Ultrasound or fluoroscopic guidance is strongly recommended 1
• Knee and hand joints: Imaging guidance helpful but not mandatory 1
• Spine interventions: Image guidance (fluoroscopy) should be used for both interlaminar and transforaminal epidural injections 2

Epidural Steroid Injections

For spine pain, epidural steroid injections should be administered with specific techniques:

• Transforaminal approach: Must use fluoroscopic guidance to confirm correct needle position and contrast spread before injection 2
• Interlaminar approach: Image guidance may be considered but is not mandatory 2
• Indications: Should be used for radicular pain or radiculopathy as part of a multimodal treatment regimen 2

Technique Considerations

Intra-articular Injections

1. Use strict aseptic technique for all injections 3
2. Inspect suspension for clumping before withdrawal 3
3. Inject without delay after withdrawal to prevent settling in syringe 3
4. For joint injections, follow standard intra-articular technique 3

Intramuscular Injections

1. For systemic therapy, inject deeply into the gluteal muscle 3
2. Use minimum needle length of 1½ inches for adults (longer for obese patients) 3
3. Use alternative sites for subsequent injections 3

Special Considerations

Nasal Steroid Administration

When administering nasal steroids:

• Hold the spray in the opposite hand in relation to the nostril being treated 2
• Keep head in upright position 2
• Breathe in gently during spraying 2
• Do not close the opposite nostril 2

Post-Injection Care

• Avoid overuse of injected joints for 24 hours following intra-articular therapy 2
• Complete immobilization is discouraged 2

Frequency and Limitations

• Maximum recommended frequency: No more than once every 6 weeks in the same joint, and no more than 3-4 injections per year 1
• Repetitive injections appear to be contraindicated as they may contribute to joint destruction 4

Safety Warnings

• Monitor blood glucose levels for 1-3 days after injection, particularly in diabetic patients 2
• Be aware of potential systemic absorption that can cause adrenal suppression, hyperglycemia, and reduced bone mineral density 5
• Consider lower doses when effective to minimize systemic effects 1

Contraindications

• Infected joints 1
• Caution with triamcinolone hexacetonide due to risk of tissue necrosis 1
• High bleeding risk may require special consideration but is not an absolute contraindication 2

By following these guidelines for steroid injection administration sites and techniques, clinicians can maximize therapeutic benefits while minimizing potential complications.