FAQs: Musculoskeletal Radiology (MSK)

What procedures do you offer for the MSK joint injection clinic?

We perform fluoroscopic or ultrasound guided steroid injections for joints or tendon sheaths for patients who are symptomatic and under the care of a rheumatologist, orthopedist, or sports medicine physician. We also perform arthrograms in which we inject contrast dye into a joint  prior to an MRI.

What procedures do you offer for the MSK US clinic?

We perform musculoskeletal ultrasound exams for sports medicine, rheumatologic or orthopedic indications. These procedures are performed by pediatric trained sonographers under the direct supervision of the attending pediatric musculoskeletal radiologist.

Who is performing my procedure in the joint injection clinic?

All procedures are performed or supervised by an attending radiology physician with subspecialty training in pediatric musculoskeletal radiology. Texas Children’s Hospital is a teaching institution and residents and fellows (radiologists-in-training) may perform the procedure under the direct supervision of an attending radiology physician. If you prefer that the procedure be performed only by the attending physician, please let us know at the time of arrival for your procedure.

Are there differences in the joint injection clinic and MSK ultrasound clinic at Texas Children’s Hospital Main Campus and Texas Children’s Hospital West Campus?

Clinics at the Main Campus and the West Campus are staffed by the same attending radiology physicians with subspecialty training in pediatric musculoskeletal radiology.

How long does the steroid joint injection/arthrogram take?

Once you get into the procedure room, a typical joint injection/arthrogram will take approximately 10-20 minutes. If a MRI is ordered to follow your injection, then expect to stay another 45-60 minutes for scanning time.

Will the steroid joint injection/arthrogram hurt?

We apply topical lidocaine to the skin 15 minutes before starting the procedure to numb the skin and lessen the pain. A local injection of lidocaine is also given to further minimize the pain.

How will I feel after my arthrogram? Can I take anything for pain once I go home?

During an arthrogram we inject enough contrast dye to distend the joint so that the MRI pictures are adequate to make a diagnosis. A majority of patients do not feel pain and only complain of their joint feeling “full” or “tight” with minor discomfort that will subside within 24-48 hours. Any over the counter non-steroidal pain reliever can be taken by mouth to relieve this discomfort. Some patients may feel pain that can radiate down the leg and will need stronger non-steroidal pain relievers that require a prescription.

What are the risks of an arthrogram?

An arthrogram is a generally safe but invasive procedure potential risk of bleeding or infection.  Infection occurs in approximately 1 in 300 procedures.

Will the steroid joint injection work for me?

The steroid injected into your joint will often relieve your pain for several months. If your discomfort does not get relieved by the steroid injection, then inform your ordering physician because your pain may be originating from a different source and this should be further evaluated.

Why do I need to schedule these injections under x-ray (fluoroscopy) or ultrasound for my child?

With fluoroscopy or ultrasound we can best guide the needle into your child’s joint space or tendon sheath quickly and, most important, safely.

What medicines do you inject into the joint space?

The Kenalog we use for steroid injections can give you relief for up to 4-6 months. We may also give  an immediately acting anesthestic called Ropivicaine. The anesthetic effect of Ropivicaine will last for about 1 day and act as a bridge until the Kenalog begins working.

Can I repeat steroid injections multiple times if my pain comes back?

Yes, steroid injections can be given multiple times. You should consult your ordering physician to see if repeat injections are indicated for your pain. It is important to remember that these injections can provide temporary relief and do not cure your child’s condition.

What instructions must be followed after receiving a steroid joint injection?

Motion of the affected joint and physical therapy should be avoided for 48 hours following the injection. A splint will be placed and should only be removed for bathing during this time.

Who do I call if I have a fever >101 degrees Fahrenheit, or have pain that is not relieved with non-steroidal medications?

If a fever >101 degrees Fahrenheit develops within a few days after the joint injection,  immediately consult your primary physician for assistance or go to an emergency room  because this may indicate the presence of an infection that requires prompt treatment. If you have pain that is not relieved with over the counter non-steroidal medications, please call 832-826-5336 and a radiology physician or nurse will help you.