The choice of injection portal is either superolateral under the patella with the knee extended or through the inferomedial or inferolateral soft part of the knee with the knee flexed to 90 degrees. Always use an aseptic technique. You do not need to aspirate the knee first unless there is a large effusion.
The best approach to a knee injection is the path of least obstruction and maximal access to the synovial cavity, which could be superolateral, superomedial, or anteromedial/anterolateral.
Clean the area with alcohol or iodine. Insert the needle into the space between the patella and femur parallel to the middle facet of the patella using the ink spot as the point of entry. Angle the needle to the centre of the patella and inject the mixture into the space between the patella and the femur (Figure 1).
The four best places for an intramuscular injection are the shoulder, hip, thigh, and buttock. Clean the site with an alcohol swab, insert the needle at a 90-degree angle, and avoid massaging the area afterward. Dispose of needles in a sharps container after each injection.
Areas with dense nerve endings or tight spaces, such as the sole of the foot (plantar fascia) or small joints in the hand, tend to be more uncomfortable. In contrast, larger joints like the knee, shoulder, or hip are generally less painful due to more room for the injection and fewer surface nerves.
The length of cortisone pain relief varies
“As a result, factors including the condition treated, the joint affected, and the patient's overall health will have an impact on the effectiveness of the injection. Generally, a cortisone shot can suppress pain for anywhere from six weeks to six months.”
Cortisone's role is to reduce inflammation, but if your pain is caused by something else—such as structural joint damage, nerve irritation, or advanced tissue degeneration—the shot will not provide the relief you were hoping for.
Injections can also be administered in the wrong site. The most common error is steroid injections (for example, Kenalog) administered into the deltoid or thigh instead of gluteal muscle. Deep intramuscular steroid injections must be given into the large muscles of the buttock.
This increases the risk of injecting the medication into the fat instead of the muscle—which means the medicine may not work the way it's supposed to. Some people pinch as a distraction technique (a quick squeeze before the poke), and while that's totally fine as long as they let go before inserting the needle.
The abdomen, thighs, and upper arms all provide similar absorption and results. What matters most is proper injection technique, consistent site rotation, and finding locations that feel comfortable for you. These practices help prevent tissue damage and ensure reliable medication absorption.
1. You aren't moving enough. One of the biggest mistakes we see patients with knee pain make is to begin using their knees less. For example, if you have osteoarthritis and moving your knee hurts, you may think the best approach is to rest your joint and let it heal.
Knee gel injections are a treatment for arthritis in your knee joint. Technically, they're hyaluronic acid injections. Hyaluronic acid is a natural lubricant found in many of your body's tissues. It's also the main ingredient in synovial fluid, which lubricates your joints.
For other types of joint injections (such as those in the knee, shoulder, or hip) pain relief may begin within 24 to 72 hours, particularly if a local anesthetic is used. Corticosteroids in these injections generally take 3 to 5 days to begin working, with maximum relief occurring in up to 10 days.
Compared to cortisone injections, PRP therapy offers several advantages: Reduced risk of side effects: PRP is derived from the patient's own blood, minimizing the risk of allergic reactions or other adverse effects.
Cortisone Shots in the Knee
Corticosteroids (cortisone) injections are often used to treat arthritis-related knee pain. Corticosteroids are powerful medications that reduce inflammation. When injected into the knee joint, cortisone can control inflammation and pain for several weeks or months.
Nearly the entire needle should enter the muscle. You definitely want to draw your plunger back slightly to make sure no blood comes into the syringe. If blood does appear, you've hit a blood vessel and need to pull out and try again. Inject your substance slowly.
Let go of the skin fold. If you bleed a little, apply pressure over the shot area. You can use your finger, a cotton ball, or a piece of gauze. To help avoid bruising, don't rub the area.
Medication leakage – If the needle does not penetrate deep enough into muscle tissue, the medication administered may leak into fatty tissue, reducing its effectiveness.
Adults: Inject approximately 1cm away from the belly button if using a 4mm or 5mm pen needle length. Children: Insert the needle 2 adult fingerbreadths away from the belly button, and avoid any protruding bones. If using a longer pen needle consult your healthcare professional.
Warning Signs You Should Not Ignore
Persistent numbness, tingling, or weakness in an arm or leg. Sharp, radiating pain that doesn't improve. Increasing redness, warmth, swelling, drainage, or fever. Limited mobility or loss of function near the injection area.
Also, if you are injecting into your arm, try pumping up your veins by opening and closing your fist. If you use one correctly, a tourniquet will make your veins considerably easier to see and inject into. But that's only if you use a tourniquet in the right way.
Hyaluronic Acid Injections (Viscosupplementation)
Unlike cortisone shots, hyaluronic acid injections don't just suppress the feeling of pain being experienced, they reduce friction in the joints and help protect your cartilage and bone from further damage.
If the initial cortisone shot didn't work, your doctor may recommend trying steroid injections. Steroid injections use a different type of steroid than cortisone to reduce inflammation and pain. These injections are usually given directly into the joint or the surrounding tissue.
For the first 48 hours after your cortisone injection in your knee, it is important to stay off your feet and rest whenever you can. After a day or two, you may resume light physical activity as tolerated. You can start to do gentle range-of-motion exercises 10 to 14 days after your cortisone injection in your knee.