Joint Injection Therapy

Q: How long do joint injections last?

Duration varies by injection type. Corticosteroid injections typically provide relief for 4–12 weeks; hyaluronic acid for 6–12 months in knee osteoarthritis; PRP for 6–18 months or longer in many studies. Your physician will set realistic expectations based on your diagnosis and injection type.

Q: How many cortisone injections can I get per year?

Most orthopedic guidelines recommend no more than 3–4 cortisone injections per year in any single joint, with at least 6–8 weeks between injections in the same area. Frequent cortisone use can have adverse effects on cartilage and tissue. If you are approaching this limit, your physician may recommend hyaluronic acid, PRP, or a surgical evaluation.

Q: How quickly will I feel relief after a joint injection?

Corticosteroid injections often begin providing relief within 2–5 days with peak effect at 1–2 weeks. Hyaluronic acid may take 2–4 weeks to reach full effect. PRP produces improvement over 4–8 weeks with continued progress over several months. Timelines vary by individual patient and diagnosis.

Q: What is the difference between a cortisone shot and a PRP injection?

Cortisone delivers a synthetic anti-inflammatory steroid that rapidly suppresses pain but does not address underlying tissue damage. PRP delivers a concentration of your own growth factors that actively stimulate healing and tissue regeneration. Cortisone provides faster, shorter-term relief; PRP works more gradually but often provides longer-lasting benefit and is regenerative rather than suppressive.

Q: Do I need imaging before getting a joint injection?

Prior imaging is not always required but can help confirm the diagnosis and plan treatment. For straightforward presentations, prior imaging may not be needed. For complex cases or joints with less clear anatomy (such as the hip), prior MRI or X-ray is often recommended. We use in-office ultrasound during every injection for real-time guidance, regardless of prior imaging status.

What is joint injection therapy?

Joint injection therapy refers to the delivery corticosteroids, hyaluronic acid, or platelet-rich plasma directly into a joint space, bursa, or tendon sheath to relieve pain, reduce inflammation, and improve function. At Maryland Orthopedic Specialists, we perform joint injections at our Bethesda and Germantown, MD offices for patients throughout Montgomery County seeking relief from arthritis, bursitis, tendinopathy, and other musculoskeletal conditions.

Types of Joint Injections We Offer

1. Corticosteroid Injections

Corticosteroid (cortisone) injections deliver a powerful anti-inflammatory medication directly into the joint or surrounding tissue, providing rapid and often significant relief of pain and swelling. They are best suited for patients experiencing an acute inflammatory flare — such as an arthritis exacerbation, bursitis, or an acute tendinopathy — and can produce relief within days of the procedure. While cortisone is highly effective in the short term, the frequency of injections must be managed carefully, as repeated use in the same joint has been associated with cartilage softening and tendon changes over time; most guidelines recommend no more than three to four injections per year in a given joint.

2. Hyaluronic Acid (Viscosupplementation)

Hyaluronic acid injections — also called viscosupplementation — work by supplementing the natural synovial fluid within the joint, restoring lubrication, cushioning, and shock absorption that is lost as osteoarthritis progresses. These injections are FDA-approved for the treatment of knee osteoarthritis and are typically administered as a series of one to five injections given one week apart, depending on the specific product used. Viscosupplementation is a good option for patients with mild-to-moderate knee osteoarthritis who have had limited or short-lived benefit from cortisone injections, prefer to minimize steroid exposure, or are not yet candidates for surgical intervention.

3. Platelet-Rich Plasma (PRP)

PRP is an autologous biologic injection derived from your own blood that concentrates growth factors to stimulate tissue healing rather than simply suppressing inflammation. It is an excellent option for patients seeking a regenerative approach — particularly those who want to avoid repeated cortisone injections or who have had diminishing returns from steroid therapy. PRP has the strongest evidence base for knee osteoarthritis, tennis elbow, Achilles tendinopathy, and plantar fasciitis. Learn more about how PRP works and the conditions it treats on our dedicated Regenerative Medicine & PRP Injections page.

4. Aspiration (Joint Fluid Removal)

Joint aspiration involves the removal of excess synovial fluid (effusion) from a joint using a needle and syringe. It is most commonly performed at the knee, which is particularly prone to fluid accumulation in the setting of osteoarthritis, gout, pseudogout, or traumatic injury. Aspiration provides immediate mechanical relief by decompressing a tense, swollen joint, and the fluid removed can be sent for laboratory analysis to evaluate for infection, crystal disease, or inflammatory arthritis. Aspiration is frequently performed in combination with a therapeutic injection — removing the fluid first and then injecting the medication through the same needle approach — for efficiency and patient comfort.

Joints We Inject

Our physicians are experienced in performing injections into a wide range of joints and soft tissue structures throughout the body:

Upper Extremity

Shoulder (glenohumeral joint)
Elbow
Wrist
Thumb (CMC joint)
Finger joints (PIP, DIP, MCP)
Olecranon bursa

Lower Extremity & Spine

Knee
Hip
Ankle
Sacroiliac joint
Foot (plantar fascia, tarsal joints)
Trochanteric bursa (hip)
Prepatellar & infrapatellar bursa

Ultrasound Guidance: Why It Matters

Not all joint injections are the same — and where the medication is delivered within the joint space or tissue makes a clinically meaningful difference. Traditional landmark-based injections rely on external anatomical markers to estimate needle placement, which can result in suboptimal positioning, particularly in deeper joints like the hip or in patients with altered anatomy. Research published in orthopedic and radiology literature consistently demonstrates that ultrasound-guided injections achieve significantly higher accuracy rates than landmark-guided techniques, with some studies showing accuracy improvements of 40 to 80 percent for specific joints.

At Maryland Orthopedic Specialists, our physicians use in-office musculoskeletal ultrasound to visualize the target structure in real time during every injection. This means the needle tip is tracked as it advances into the joint, tendon sheath, or bursa — ensuring the therapeutic agent is deposited precisely where it will be most effective. Ultrasound guidance is particularly valuable for hip injections, shoulder injections, small joint injections, and PRP delivery, where accuracy directly impacts clinical outcome.

What to Expect

Before Your Injection

Your physician will review your medical history, current medications, and prior imaging before recommending a specific injection type. Please inform us if you are taking blood thinners, diabetes medications, or have a known allergy to any injectable medications. You do not need to fast before a joint injection, and most patients drive themselves to and from the appointment. If you are receiving a lower extremity injection, consider wearing loose-fitting clothing for easy access to the injection site.

During the Procedure

You will be positioned comfortably on an examination table. The skin over the injection site is cleaned thoroughly with antiseptic solution. In many cases, a topical or injected local anesthetic is applied to minimize discomfort during needle entry. Using ultrasound guidance, the physician advances the needle to the target location and confirms positioning before delivering the injection. The procedure itself typically takes 5 to 10 minutes from start to finish, and most patients tolerate it well.

After the Injection

You may experience mild soreness or achiness at the injection site for 24 to 48 hours following the procedure — this is normal and typically subsides quickly. Applying ice to the area for 15 to 20 minutes several times during the first day can help. For cortisone and hyaluronic acid injections, NSAIDs may be taken as needed for discomfort. For PRP injections, NSAIDs should be strictly avoided for at least two weeks, as they can blunt the healing response. Most patients resume normal activities the following day, though high-impact activity may be restricted for a brief period depending on the injection type and site. Your physician will provide written post-injection instructions tailored to your specific procedure.

Frequently Asked Questions

How long do joint injections last?

The duration of relief varies by injection type and individual patient factors. Corticosteroid injections typically provide relief for four to twelve weeks, though some patients experience benefit for several months. Hyaluronic acid injections for knee osteoarthritis can provide relief for six to twelve months in well-selected patients. PRP injections, depending on the condition, have demonstrated durable benefit lasting six to eighteen months or longer in clinical studies. Your physician will set realistic expectations based on your specific diagnosis and injection type during your consultation.

How many cortisone injections can I get per year?

Most orthopedic guidelines recommend limiting cortisone injections to no more than three to four injections per year in any single joint, with a minimum interval of six to eight weeks between injections in the same area. This recommendation exists because frequent or high-dose cortisone can have adverse effects on cartilage and surrounding tissues over time. If you are reaching the recommended limit of cortisone injections and still experiencing significant pain, your physician may recommend transitioning to hyaluronic acid, PRP, or a surgical evaluation.

Is the injection painful?

Discomfort during a joint injection is typically mild to moderate and brief. Many patients describe it as similar to a blood draw or a brief pressure sensation. We use local anesthetic preparation and ultrasound guidance to make the procedure as comfortable as possible. Some patients experience a brief ache during needle advancement or when the medication is delivered into the joint. Post-injection soreness may occur for one to two days but is generally manageable with ice and, for most injection types, over-the-counter pain relievers.

How quickly will I feel relief after a joint injection?

This depends on the type of injection. Corticosteroid injections often begin providing noticeable relief within two to five days, with peak effect at one to two weeks. Hyaluronic acid injections may take two to four weeks to reach full effect, as the lubricating mechanism is gradual. PRP works through a biological healing process and typically produces improvement over four to eight weeks, with continued progress over several months. If you receive a corticosteroid injection, you may feel temporary soreness for the first day or two before improvement begins, which is normal.

What is the difference between a cortisone shot and a PRP injection?

A cortisone shot delivers a synthetic anti-inflammatory steroid that rapidly suppresses pain and swelling but does not address the underlying tissue damage. PRP, by contrast, delivers a concentration of your own growth factors that actively stimulate the body's healing response and promote tissue regeneration. Cortisone typically provides faster, more immediate relief but shorter duration; PRP works more gradually but often provides longer-lasting benefit and has a regenerative rather than suppressive effect on tissue. The two injections are not interchangeable — each is best suited for different clinical situations, and your physician will help determine which is most appropriate for your diagnosis.

Do I need imaging before getting a joint injection?

Imaging before a joint injection is not always required, but it can be very helpful in confirming the diagnosis, evaluating the degree of joint degeneration, and planning the most appropriate treatment approach. For straightforward knee or shoulder injections with a clear clinical diagnosis, prior imaging may not be necessary before proceeding. For complex cases, atypical presentations, or joints with less clear anatomy — such as the hip or sacroiliac joint — prior MRI or X-ray is often recommended. In our office, we use in-office ultrasound during the injection itself for real-time guidance, regardless of prior imaging status.

Medically reviewed by Christopher S. Raffo, MD

Last reviewed May 1, 2026

References

American Academy of Orthopaedic Surgeons (AAOS). orthoinfo.aaos.org